Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application

Firoz, Tabassum; Romero, Carla Lionela Trigo; Leung, Clarus; Souza, João Paulo; Tunçalp, Özge

doi:10.1136/bmjgh-2021-007077

Cited by 17 publications

(16 citation statements)

References 75 publications

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“…While most have healthy deliveries, 20%-30% undergo a highly stressful childbirth experience. 1,2 A significant minority experience potentially lifethreatening events and even maternal "near-miss" (nearly escaping death) in relation to childbirth, with rising rates in the U.S. 3 Increasing evidence reveals that women can develop post-traumatic stress disorder in response to childbirth (CB-PTSD). 4 Maternal CB-PTSD is estimated to occur in 3%-6% of the postpartum population 5,6 and in nearly 20% of those who experience complicated deliveries.…”

Section: Introductionmentioning

confidence: 99%

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory

Jagodnik

Ein‐Dor²,

Chan

et al. 2023

Preprint

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Background: Maternal psychiatric morbidities include a range of psychopathologies; one condition is post-traumatic stress disorder (PTSD) that develops following a traumatic childbirth experience and may undermine maternal and infant health. Although assessment for maternal mental health problems is integrated in routine perinatal care, screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic event strongly associates with PTSD. The brief 13-item Peritraumatic Distress Inventory (PDI) is a common tool to assess acute distress in non-postpartum individuals. How well the PDI specified to childbirth can classify women likely to endorse CB-PTSD is unknown. Objectives: We sought to determine the utility of the PDI to detect CB-PTSD in the early postpartum period. This involved examining the psychometric properties of the PDI specified to childbirth, pertaining to its factorial structure, and establishing an optimal cutoff point for the classification of women with high vs. low likelihood of endorsing CB-PTSD. Study Design: A sample of 3,039 eligible women who had recently given birth provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis (EGA) and bootstrapping analysis to reveal the factorial structure of the PDI and the optimal PDI cutoff value for CB-PTSD classification. Results: Factor analysis of the PDI shows two strongly correlated stable factors based on a modified 12-item version of the PDI consisting of (1) negative emotions and (2) bodily arousal and threat appraisal in regard to recent childbirth. This structure largely accords with prior studies of individuals who experienced acute distress resulting from other forms of trauma. We report that a score of 15 or higher on the modified PDI produces strong sensitivity and specificity. 88% of women with a positive CB-PTSD screen in the first postpartum months and 93% with a negative screen are identified as such using the established cutoff. Conclusions: Our work reveals that a brief self-report screening concerning a woman's immediate emotional reactions to childbirth that uses our modified PDI tool can detect women likely to endorse CB-PTSD in the early postpartum period. This form of maternal mental health assessment may serve as the initial step of managing symptoms to ultimately prevent chronic symptom manifestation. Future research is needed to examine the utility of employing the PDI as an assessment performed during maternity hospitalization stay in women following complicated deliveries to further guide recommendations to implement maternal mental health screening for women at high risk for developing CB-PTSD.

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Section: Introductionmentioning

confidence: 99%

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory

Jagodnik

Ein‐Dor²,

Chan

et al. 2023

Preprint

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“…4 Moreover, improving the quality of care tailored to the needs of women is considered a key component of the right to health, and the route to equity and dignity for them. [5][6][7] Despite the WHO's recommendation for having a vision beyond the numbers, facilities now have focused on physical recovery rather than psychological and emotional impact on women. 8 Recent studies of near-misses from around the world have drawn attention to the negative psychological impact of maternal morbidities.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Moreover, improving the quality of care tailored to the needs of women is considered a key component of the right to health, and the route to equity and dignity for them. 5 - 7 …”

Section: Introductionmentioning

confidence: 99%

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study

Abdollahpour,

Heydari,

Ebrahimipour

et al. 2023

J Caring Sci

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Introduction: A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM. Methods: In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis. Results: The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes. Conclusion: Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs’ unmet needs.

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“…5 Even a good news recent systemic review and metaanalysis of the WHO MNM criteria uptake in LIC showed that despite good uptake in these countries enabling some intercountry comparisons, there was still the need in individual countries for contextual adaptations. 6 Surely the conversation needs to change. A search for peerreviewed research on SMM and MNM reviews revealed 100s of articles on defining, re-defining, counting, rates, associated factors, preventability, and opportunities for improvements.…”

mentioning

confidence: 99%

“…The authors concluded that global standardising was ‘not feasible at this time’ 5 . Even a good news recent systemic review and meta‐analysis of the WHO MNM criteria uptake in LIC showed that despite good uptake in these countries enabling some intercountry comparisons, there was still the need in individual countries for contextual adaptations 6 …”

mentioning

confidence: 99%

Severe maternal morbidity – we need more action to prevent harm

MacDonald,

Lawton,

Storey

et al. 2024

Aust NZ J Obst Gynaeco

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Reviewing severe maternal morbidity (SMM) is considered a marker of the quality of maternity care, as in high income countries (HIC) maternal mortality is thankfully now rare. 1 SMM disrupts maternal (and wider family) wellbeing, causing considerable personal and public cost. SMM preventability review has the potential to reduce this and the associated harm. To do this, we must identify its occurrence, review these cases, and analyse findings to develop appropriate system improvements.As Joanne Frost and her colleagues in this current Australian and New Zealand Journal of Obstetrics and Gynaecology state, there is currently no national consensus or agreement in Australia on terms to use, definitions to follow and therefore no ability to compare inter-state data on the rates and causes of SMM. There is also no defined process to assess preventability in Australia and without this at the outset it is difficult to see how change would be effected. While in Aotearoa (New Zealand), our Health Research Council has previously funded research to enable national SMM preventability reviews, across both countries there appears to be no will by our respective governments to provide ongoing funding to enable routine SMM preventability reviews to take place. 2 No funding is currently available at regional, state, or national levels, and there is no apparent plan for these reviews to become 'business as usual'. This is regrettable, as opportunities are being missed to improve poor maternal and baby outcomes.

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Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application

Cited by 17 publications

References 75 publications

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study

Severe maternal morbidity – we need more action to prevent harm

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