Maternal near-miss audit: Lessons to be learnt

Abstract

Mother and child constitute a large, vulnerable, and a priority group as the risk is involved with childbearing in women and of growth and development in children. For every woman who dies from pregnancy or childbirth-related causes, it is estimated that twenty more suffer from pregnancy-related illness or experience other severe complications. These women who nearly escape death are categorized under “near miss” which has been defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Maternal near-miss audits give us an opportunity to study the cases which were almost similar to those where maternal deaths happened; thus, their review may give concrete evidence of reasons/deficiencies in health care leading to severe complications and even grave consequences as maternal deaths. Near-miss audits will allow the care of critically ill women to be analyzed, deficiencies in the provision of care to be identified, and comparison within and between institutions and, ultimately, improve the quality of obstetric care and further reduce maternal morbidity and mortality.

Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study

“…MNM and MD) acts as a positive entry point and provides valuable information; it is not enough to create sustainable changes in obstetric care. Therefore, it is recommended that direct interviews be conducted with survivors and service providers to obtain a deeper understanding regarding the deficiencies in care provision, thereby improving the quality of obstetric care (4,7,35).…”

“…Despite the worldwide reduction in maternal mortality (MM) through the increased birth coverage in health facilities (1), the rate of MM remains high in resource-poor settings (2,3). For every female that dies of pregnancyrelated causes, 20 or more cases experience acute or chronic morbidity (4).…”

“…The term "near miss" denotes a condition of "a female that nearly died, but survived a complication that occurs during pregnancy, childbirth, or within 42 days of termination of pregnancy" (3). Since MNM could act as a surrogate of maternal death (9), the implementation of MNM audit at hospital level can provide an opportunity to study maternal morbidity at a large scale (4).…”

“…It also provides an objective assessment tool to compare and monitor obstetric quality of care in health facilities among females experiencing severe complications over time (7,10). Moreover, MNM audit is more acceptable for hospital staff to discuss survival causes in such females after experiencing life-threatening conditions (4,7).…”

Pragmatic approach to halt preventable maternal and neonatal deaths in Nigeria

“…As such, the quality of perinatal care at the healthcare facilities is key to reduction in maternal and neonatal mortality Nigeria has witnessed a disproportionate increase in facility delivery in many regions of the country (28). The increase in the rate of miss has been defined as a critically ill pregnant or recently delivered woman who survived a complication and narrowly escaped death during pregnancy, childbirth or within 42days of termination of pregnancy (40,41). Although there is no standard definition of neonatal near miss, a neonatal near miss could be a useful indicator to assess and improve quality in the context of neonatal care.…”