A scoping review of maternal near miss assessment in Australia, New Zealand, South‐East Asia and the South Pacific region: How, what, why and where to?

Abstract

Background: Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. Aims:To review the scope of MNM studies undertaken in Australia, New Zealand, South-East Asia and the South Pacific region. Materials and Methods:A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. Results:The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre-eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective.Conclusions: Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longerterm health outcomes, aspects of preventability and financial implications for health services.

Severe acute maternal morbidity reporting in Australia: Why is it so hard?

“…The literature describes various methods for investigating SAMM in Australia, including: prospective cross-sectional studies, 14 retrospective cohort studies collated using administrative and population health datasets, 14,15 and condition-specific registries. 16 A voluntary national reporting system, The Australasian Maternity Outcomes Surveillance System (AMOSS), was used to research selected rare and serious conditions in pregnancy 16 (details in Table 1).…”

Severe maternal morbidity – we need more action to prevent harm

“…12,13 The causes of the majority of SMM globally are sepsis, haemorrhage (usually postpartum haemorrhage), hypertensive disorders, mainly preeclampsia and eclampsia, and pre-existing co-morbidities such as cardiovascular disease and the management of these disease processes. 14 Different jurisdictions have shown that between 30 and 60% of SMM is preventable and that the commonest factors are provider (clinician) or system-related rather than being related to the pregnant person or their family. 2,14,15 Related to SMM, within-country inequities must be highlighted to show how maternity care systems might be privileging whiteness.…”

“…14 Different jurisdictions have shown that between 30 and 60% of SMM is preventable and that the commonest factors are provider (clinician) or system-related rather than being related to the pregnant person or their family. 2,14,15 Related to SMM, within-country inequities must be highlighted to show how maternity care systems might be privileging whiteness. 16 Non-Hispanic Black American women suffer much higher rates of SMM than non-Hispanic Whites in the USA.…”

“…17,18 In Australia, Indigenous First Nations women probably suffer more SMM than White Australians -they have three times the maternal mortality rate. 14,19 In Aotearoa, Indigenous wāhine Māori (Māori women) suffer higher rates of maternal death and perinatal loss than white New Zealand Europeans, and Pacific women suffer the highest rates of preventable SMM. 2 Non-white minority ethnic groups in the Netherlands and UK experience similar disparities which are not explained by known risk factors for severe maternal morbidity.…”

“…The review of cases of SMM is recognised globally as a quality measure to evaluate maternity care standards as these cases are 50–100 times more common than maternal mortality in HIC 12,13 . The causes of the majority of SMM globally are sepsis, haemorrhage (usually postpartum haemorrhage), hypertensive disorders, mainly pre‐eclampsia and eclampsia, and pre‐existing co‐morbidities such as cardiovascular disease and the management of these disease processes 14 . Different jurisdictions have shown that between 30 and 60% of SMM is preventable and that the commonest factors are provider (clinician) or system‐related rather than being related to the pregnant person or their family 2,14,15 …”