Network for Surveillance of Severe Maternal Morbidity: a powerful national collaboration generating data on maternal health outcomes and care

Abstract

Objective To identify cases of severe maternal morbidity (SMM) during pregnancy and childbirth, their characteristics, and to test the feasibility of scaling up World Health Organization criteria for identifying women at risk of a worse outcome.Design Multicentre cross-sectional study.Setting Twenty-seven referral maternity hospitals from all regions of Brazil.Population Cases of SMM identified among 82 388 delivering women over a 1-year period.Methods Prospective surveillance using the World Health Organization's criteria for potentially life-threatening conditions (PLTC) and maternal near-miss (MNM) identified and assessed cases with severe morbidity or death.Main outcome measures Indicators of maternal morbidity and mortality; sociodemographic, clinical and obstetric characteristics; gestational and perinatal outcomes; main causes of morbidity and delays in care.Results Among 9555 cases of SMM, there were 140 deaths and 770 cases of MNM. The main determining cause of maternal complication was hypertensive disease. Criteria for MNM conditions were more frequent as the severity of the outcome increased, all combined in over 75% of maternal deaths.Conclusions This study identified around 9.5% of MNM or death among all cases developing any severe maternal complication. Multicentre studies on surveillance of SMM, with organised collaboration and adequate study protocols can be successfully implemented, even in low-income and middle-income settings, generating important information on maternal health and care to be used to implement appropriate health policies and interventions.Keywords Audit, Brazil, maternal near miss, obstetric care, potentially life-threatening complications of pregnancy, severe maternal morbidity.Tweetable abstract Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil.

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

“…35 There was also a similarity between the causes of MNM and those of maternal death in Brazil. Direct obstetric causes still prevail, but indirect ones are increasing.…”

“…35 Several articles originated from this population data, although there were no comparative studies among these 9,555 women and those who had their childbirths in the 27 units, however presenting no complications. The aspects that differ from the methodology of the study are shown in Table 2, along with each of the 13 articles.…”

“…They were organized in two research groups. The first refers to two articles from the "Nascer no Brasil" ("Born in Brazil") study, 5,34 the second reports 13 articles from the Multicenter Study of the "Rede Nacional de Vigilância de Morbidade Materna Grave" [35][36][37][38][39][40][41][42][43][44][45][46][47] ('National Surveillance Network on Severe Maternal Morbidity"). All articles of national scope used the WHO criteria for near miss.…”

“…The aspects that differ from the methodology of the study are shown in Table 2, along with each of the 13 articles. Cecatti et al 35 present overall results, and the other articles explore MNM according to age group 36 and with specific conditions: abortion, 37 ectopic pregnancy, 38 hypertensive diseases, 39,40 hemorrhage, 41,42 infections, 43,44 heart diseases. 45 Healthcare factors were also analyzed, such as quality of care 46 and the association with cesarean section 47 based on Robson's Classification.…”

Antenatal anaesthesia clinics – the way forward?

“…From the information given it is difficult to assess the overall numbers that should be expected. One of the criticisms of this paper is the lack of denominator data which means that many assumptions are based on data from other populations: for example the authors’ estimates of morbidity are based on Brazilian data [11]. The prevalence of medical co-morbidities among Israeli parturients would illuminate the data provided.…”