Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries?

Abstract

Objective To assess whether severe acute maternal morbidity (SAMM, 'near misses') can be used as a surrogate of an analysis of maternal deaths to describe the pattern of severe maternal disease and avoidable factors related to it. Design Prospective, descriptive study.Setting A SAMM and maternal mortality audit was conducted in three clearly defined geographical areas, consisting of rural and urban settings in South Africa. Population Indigent black African pregnant women.Method Cases of SAMM and maternal deaths were collected in the areas and a comparison was made of the disease profiles and avoidable factors, missed opportunities and substandard care. Main outcome measures The proportion of primary obstetric causes and avoidable factors in women with SAMM and maternal deaths, and the mortality indices of the primary obstetric causes of death and organ system dysfunction. Results A total of 423 women with SAMM and 128 maternal deaths were collected over two years.Demographic factors were similar between the groups except that significantly more maternal deaths had not attended any antenatal care. The primary obstetric causes of SAMM and maternal death did not correlate. The four most common causes of SAMM were complications of hypertension (27.2%), postpartum haemorrhage (18.0%), antepartum haemorrhage (12.8%) and abortion (11.3%), whereas the four most common causes of maternal death were non-pregnancy related sepsis (26.6%), complications of hypertension (23.4%), pre-existing medical disease (14.1%) and abortion (10.9%). The types of avoidable factors were similar between both groups although administrative factors occurred significantly more frequently in the maternal death group as did poor problem identification and monitoring. Conclusion Review of SAMM gives a different disease pattern to that obtained from maternal death audits.However, in diagnosing inadequacies in the health system, similar information was obtained.

Severe acute maternal morbidity: study of epidemiology and risk factors

“…9 As per the causes, both obstetric and non-obstetric, seeking ICU care, it shows that there is no change in common cause of ICU admissions over a last decade. 10 Among early pregnancy complication group, abortion-related hospital admissions predominated. This emphasises the need of monitoring it and quantifying the magnitude of adverse health effects of unsafe abortion in developing countries like India.…”

Priorities in emergency obstetric care in Bolivia––maternal mortality and near‐miss morbidity in metropolitan La Paz

“…21,22,30 Because of the resemblance in diagnostic patterns between near-miss at facility level and maternal mortality at regional level, and a reported similarity of substandard care, it has been suggested that severe morbidity can act as a surrogate analysis of maternal deaths. 31 However, the disease profile for near-miss versus maternal mortality differed considerably among the hospitals we studied, leading us to conclude that in similar settings, near-miss may be used advantageously to complement maternal mortality reviews, although it should not replace them.…”

Maternal mortality in Senegal

“…10,11 In these two reports, there was a 50% drop in maternal mortality within a 3pyear intervention period, which is similar to the pattern noted in our study. There are also several studies of facilitypbased audits of perinatal deaths, 20 uterine rupp p ture, 21 nearpmisses [22][23][24] or criterionpbased audit. 25,26 However, controlled evaluation studies of audit interventions are rare and the absolute or relative effects of these approaches on professional practices and outcomes are generally only small to moderate.…”