Severe maternal morbidity among women with a history of cesarean section at a tertiary referral teaching hospital in the southeast of Iran

Moudi, Zahra; Arabnezhad, Leyla; Ansari, Hossein; Tabatabaei, Seyed Mehdi

doi:10.1016/j.puhe.2019.07.016

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…During the study period, the previous cesarean section rate was 33.9%. It was lower than the populationbased prospective study in Italy, which found that repeated cesarean section was remarkably associated with postpartum hemorrhage and hysterectomy [14,30]. The number of scarred uterus in China doubled from 2012 to 2016,9.8% and 17.7% respectively [31].…”

Section: Discussionmentioning

confidence: 70%

“…The joint management of MNM by obstetrics and the intensive care unit (ICU) is a major measure for the rescue of emergency obstetrics. The incidence of MNM admitted to the ICU can be used as one of the important indicators to judge the severity [14]. A multicountry survey by WHO showed that the use of high-quality ICU is notably correlated with the decline in MMR [15].As a result, it is necessary to predict, identify, and manage the MNM admitted to the ICU to improve the risk prevention and control system.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

Chen¹,

Shi²,

Zhu³

et al. 2020

Preprint

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BackgroundThe maternal near-miss (MNM) criterion formulated by the WHO can dynamically evaluate the obstetric quality and maternal health in medical institutions. The study aims to explore the incidence, risk factors, and causes of MNM cases admitted to the intensive care unit (ICU) within 5 years.MethodsThis study is a retrospective study. The data of MNM admitted to the ICU comes from the medical records of Subei People's Hospital in Yangzhou from 2015 to 2019. The study subjects meet at least one World Health Organization (WHO) criterion of MNM. The MNM who had not been admitted to the ICU in the same year served as the control group. We use descriptive analysis, Chi-Square test and Fisher’s exact test for data analysis.Results151 women met the WHO criteria of MNM and there was one maternal death in 2016. The average maternal near-miss rate（MNMR）for ICU admission was 3.5 per 1,000LBs, and the average MNM morbidity was 0.36%. The average maternal mortality ratio (MMR) was 5 per 100,000LBs. The 5-year research period witnessed moderate growth in MNM admitted to the ICU. The region, referral, gravidity, prenatal examination, and mode of delivery were significantly related to the MNM admitted to the ICU(p<0.05). Concerning neonatal characteristics, there is a significant difference in preterm birth rate and low Apgar scores at 1 min and 5 min(p<0.05). The direct obstetric causes were the primary cause of MNM, regardless of the ICU admission. The leading direct obstetric causes of MNM admitted to the ICU were obstetric hemorrhage diseases(38.8%)，following hypertension diseases(18.8%), while the leading indirect obstetric cause of MNM admitted to the ICU was heart-related diseases (7.2%). MNM for the ICU admission were mostly postpartum (96.9%), who underwent multiple interventions.ConclusionsICU is one of the most important endpoints of MNM management. In the context of "universal two-child", medical institutions should strengthen multidisciplinary joint treatment. In the future, it needs to be expanded to multi-center research to determine the criteria for MNM admitted to the ICU.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

Chen¹,

Shi²,

Zhu³

et al. 2020

Preprint

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“…SMO cases in level 3 hospitals had more antenatal visits and a higher proportion of cesarean sections than SMO cases in level 2 hospitals. In addition, 33.35% of all SMO cases were women with a history of cesarean section, which was less than the 58% reported in a study at a tertiary referral teaching hospital in the southeast of Iran [31]. Although previous cesarean delivery is not considered a risk factor for SMO or adverse perinatal outcomes, there could be differences between study groups in terms of healthcare-seeking behavior, referral mechanisms, intrapartum monitoring, and clinical decision making [32].…”

Section: Demographic Differences and Birth Outcomesmentioning

confidence: 85%

Epidemiology analysis of the incidence of severe maternal outcomes between level 2 and 3 hospitals in China’s Hunan province from 2012 to 2018

Liu

Xiong

Wang

et al. 2020

Preprint

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Background: This facility-based study analyzed the epidemiology and incidence of maternal near-miss (MNM) and mortality by hospital level as part of Hunan province’s efforts to raise the quality of hospital care for women. Methods: We used data for MNM and mortality cases for 2012–2018 from 17 hospitals (12 level 2 facilities, five level 3 facilities) that receive referrals for obstetric complications in Hunan province. Data were drawn from China’s National Maternal Near Miss Surveillance System, and collected using the World Health Organization near-miss tool. We calculated the ratio of severe maternal outcomes (SMO) (i.e., MNM and maternal death [MD] cases), mortality index (MI), and MNM to mortality ratio (MNM:MD), and epidemiological factors, organ dysfunction, and maternal complications stratified by hospital level. Chi-square tests to examine differences between groups and total ratios and 95% CI were calculated. Results: There were 518 SMO cases (489 MNM and 29 MD) among 279407 live births (LBs) and 1299 SMO cases(1262 MNM and 37 MD) among 232386 LBs in level 2 and 3 facilities. The total MNM ratio in level 2 and 3 hospitals was 1.75 (95%CI: 1.60–1.91) and 5.43 (95%CI: 5.14–5.74) per 1000 LBs, respectively. There were differences in SMO cases between level 2 and 3 hospitals in maternal age, education, parity, antenatal visits, and history of cesarean sections. In MNM cases, coagulation dysfunction was the main organ dysfunction (level 2 hospitals: 59.10%; level 3 hospitals: 79.32%), and the main maternal complications were obstetric hemorrhage (level 2 hospitals: 71.98%) and hepatopathy (level 3 hospitals: 69.49%). For MD cases, the main maternal complications were neurologic dysfunction (level 2 hospitals: 41.38%) and coagulation dysfunction (level 3 hospitals: 42.55%). Anemia was the main maternal complication for SMO cases in both level 2 (69.69%) and 3 (68.59%) hospitals. Conclusions: MNM and MD is higher in level 3 hospitals compared with level 2 hospitals. The obstetric emergency capacity of level 3 hospitals is higher than that of level 2 hospitals. Future government policies should consider upgrading the obstetric emergency treatment capacity in level 2 hospitals or to re-distinguish the social functions of different medical institutions.

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“…19,20 Since the measurement of the rates and cases of MNM contributes to the audit of the quality of maternal health care, these results would reflect the interest in the evaluation or development of maternal health surveillance systems worldwide, which corresponds to some articles found on MNM published over the previous years. Other terms reported in more recent studies, such as cesarean section, preeclampsia, severe maternal outcome (smo), termination, case fatality rate, association and potentially life-threatening condition (pltc), as wellas terms that describe countries such as Brazil, Ethiopia, India, and Tanzania reflect that, in recent years, the authors have been conducting studies that measure the cases and rates of MNM according to specific maternal health conditions and their associated factors, [21][22][23][24][25] or studies for the validation of the MNM criteria in these countries. [26][27][28][29] Terms related to severe acute maternal morbidity were not included, since this is a term interchangeable with MNM, and the WHO does not recommend refering to severe, life-threatening obstetric complications.…”

Section: Discussionmentioning

confidence: 99%

Worldwide Original Research Production on Maternal Near-Miss: A 10-year Bibliometric Study

Hernández-Vasquéz

Bendezú-Quispe

Comandé

et al. 2020

Rev Bras Ginecol Obstet

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Objective To evaluate the global productivity regarding original articles on maternal near-miss (MNM). Methods We conducted a bibliometric analysis of original articles published from 2008 to November 2019 in the journals indexed in the Scopus database. The averages of the number of articles by author, of the number of authors by article, of the number of citations by article, and the total number of documents with one or more authors were obtained. An analysis of the co-citation of authors and a co-occurrence analysis of the terms included in the titles and abstracts were performed and were presented as network visualization maps. Results A total of 326 original articles were analyzed. There was an increase in the number of articles (p < 0.001; average annual growth rate = 12.54%). A total of 1,399 authors, an average number of articles per author of 4.29, with an index of authors per document of 0.23, and an index of co-authors per document of 8.16 were identified. A total of 85 countries contributed with original articles on MNM. Among the top ten countries regarding the contribution of articles, five were low and middle-income countries (LMICs). Brazil had the highest volume of production (31.1%), followed by the US (11.5%). Terms related to countries and the measurement of the rates and cases of MNM and the associated factors were found in recent years in the analysis of the co-occurrence of terms. Conclusion There was an increase in the production of original articles on MNM, with a significant participation of authors and institutions from LMICs, which reveals a growing interest in the use of MNM indicators to improve the quality of maternal health care.

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Severe maternal morbidity among women with a history of cesarean section at a tertiary referral teaching hospital in the southeast of Iran

Cited by 14 publications

References 21 publications

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

Epidemiology analysis of the incidence of severe maternal outcomes between level 2 and 3 hospitals in China’s Hunan province from 2012 to 2018

Worldwide Original Research Production on Maternal Near-Miss: A 10-year Bibliometric Study

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