Maternity wards or emergency obstetric rooms? Incidence of near‐miss events in African hospitals

Filippi, Véronique; Ronsmans, Carine; Gohou, Valerie; Goufodji, Sourou; Lardi, Mohamed; Sahel, Amina; Saizonou, Jacques; Brouwere, Vincent De

doi:10.1111/j.0001-6349.2005.00636.x

Cited by 112 publications

(68 citation statements)

References 7 publications

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“…We created a matrix with separate columns for early and late stages of pregnancy, and color-codes for marital status, for whether the severe obstetric complications arose prior or at arrival to the facility, and if care had been sought repeatedly. Separating near-miss events upon and after arrival helped to facilitate the distinction between potential pre-facility barriers and quality of care [24, 29]. We compared the overall similarities and differences of women’s narratives and field observations, and noted resemblances and contrasts in trajectories and experiences of care.…”

Section: Methodsmentioning

confidence: 99%

Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

Påfs

Musafili

Binder-Finnema

et al. 2016

BMC Pregnancy Childbirth

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Background: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. Methods: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. Results: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. Conclusion: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

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Section: Methodsmentioning

confidence: 99%

Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

Påfs

Musafili

Binder-Finnema

et al. 2016

BMC Pregnancy Childbirth

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“…(14) Studies from developing countries especially in the African region have reported a high incidence of near miss when compared to the developed world as can be seen from Table 2. (16171819202122232425262728) There are not many studies available from India on maternal near miss as is evident from Table 2.…”

Section: Prevalence Of Maternal Near Missmentioning

confidence: 99%

Maternal near miss: An indicator for maternal health and maternal care

Chhabra¹

2014

Indian J Community Med

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Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health.

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“…Although the objective criteria for defining severe maternal morbidity vary between studies, its prevalence ranges from 0.05%-1.7% in developed countries[34] and 0.6%-8.5% in resource-limited countries. [56] Critical care services are important for this subset of obstetric patients and critical care unit (CCU) admission may be considered as an objective marker of severe maternal morbidity. [78]…”

Section: Introductionmentioning

confidence: 99%

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Dasgupta

Jha

Bagchi

et al. 2017

Indian Journal of Critical Care Medicine

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Background:Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years’ period.Settings and Design:Retrospective cohort study conducted in the general critical care unit (CCU) of a government teaching hospital.Materials and Methods:The records of all obstetric patients managed in the CCU over a span of 5 years (January 2011-December 2015) were analyzed.Results:During the study, 205 obstetric patients were admitted with a CCU admission rate of 2.1 per 1000 deliveries. Obstetric hemorrhage (34.64%) was the most common primary diagnosis among them followed by pregnancy-induced hypertension (26.83%). Severe hemorrhage leading to organ failure (40.48%) was the main direct indication of admission. Invasive ventilation was needed in 75.61% patients, and overall obstetric mortality rate was 33.66%. The median duration (in days) of invasive ventilation was 2 (interquartile range [IQR] 1-7), and the median length of CCU stay (in days) was 5 (IQR 3-9).Conclusions:Adequate number of critical care beds, a dedicated obstetric high dependency unit, and effective coordination between critical care and maternity services may prove helpful in high volume obstetric centers.

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Maternity wards or emergency obstetric rooms? Incidence of near‐miss events in African hospitals

Cited by 112 publications

References 7 publications

Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

Maternal near miss: An indicator for maternal health and maternal care

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

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