Women's Reports of Severe (Near‐miss) Obstetric Complications in Benin

Filippi, Véronique; Ronsmans, Carine; Gandaho, Timothee; Graham, Wendy; Alihonou, E; Santos, P. V.

doi:10.1111/j.1728-4465.2000.00309.x

Cited by 88 publications

(93 citation statements)

References 20 publications

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“…The quantitative survey showed that the women had very good recall of morbidity experienced during pregnancy but great difficulty recalling complications they experienced during or after childbirth, as defined in medical terms, regardless of the severity of the complications they suffered. 12 The results reported here were taken from the qualitative part of the study, which focused on the whole experience of maternity, particularly of the antenatal and emergency obstetric care environment.…”

Section: Giving Birth In Maternity Hospitals In Benin: Testimonies Ofmentioning

confidence: 99%

Giving birth in maternity hospitals in Benin: Testimonies of women

Grossmann-Kendall¹,

Filippi²,

Koninck³

et al. 2001

Reproductive Health Matters

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Section: Giving Birth In Maternity Hospitals In Benin: Testimonies Ofmentioning

confidence: 99%

Giving birth in maternity hospitals in Benin: Testimonies of women

Grossmann-Kendall¹,

Filippi²,

Koninck³

et al. 2001

Reproductive Health Matters

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“…Women who experienced a life-threatening complication in pregnancy (defined as 'severe maternal illnesses which, without urgent medical attention, would lead to a mother's death' 5 ) were invited to take part in an interview study. We also invited the women's partners to participate.…”

Section: Research Questionsmentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…14,15 These estimates are based on maternal recall of complications, which may be unreliable as a result of variations in the perception of severity, misunderstandings about the complications themselves, and the time elapsed between the complication and the interview during which the information is obtained. 8,11,16,17 Despite these difficulties, population surveys using validated questionnaires have been able to provide useful information on the prevalence of maternal morbidities. 13 Thus, formal validation of questionnaires on maternal morbidity has been recommended to improve the quality of the information.…”

Section: Introductionmentioning

confidence: 99%

“…7 In settings in which integrated epidemiological surveillance with wide geographical coverage is yet to be established, community-based surveys have been suggested as a possible source of information on maternal morbidity and mortality. [8][9][10][11] Indeed, for several years, demographic health surveys (DHSs) have been used to gather information on maternal and perinatal heath in several developing countries. 12 However, in the context of large, nationwide population surveys, few such studies have used formally validated questionnaires.…”

Section: Introductionmentioning

confidence: 99%

Maternal morbidity and near miss in the community: findings from the 2006 Brazilian demographic health survey

Souza

Cecatti

Parpinelli

et al. 2010

BJOG

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Objective To obtain an estimate of the prevalence of potentially life-threatening maternal conditions and near-miss events in Brazil, and to explore the factors associated with these complications.Design A demographic health survey (DHS) focusing on reported maternal complications.Setting Data from the five geographical regions of Brazil.Population A total of 5025 women with at least one live birth in the 5-year reference period preceding their interview in the DHS.Methods A secondary analysis of the 2006 Brazilian DHS database was carried out using a validated questionnaire to evaluate the occurrence of maternal complications and related key interventions. According to a pragmatic definition, any woman reporting the occurrence of eclampsia, hysterectomy, blood transfusion or admission to the intensive care unit was considered as having experienced a near-miss event. Associations between the sociodemographic characteristics of the women and severe maternal morbidity were evaluated.Main outcome measures Proportions and ratios of complications and related interventions defined as maternal near miss in pregnancy, and estimated risk factors for maternal morbidities.Results Around 22% of women reported complications during pregnancy. The prevalence of maternal near miss in Brazil, using the pragmatic definition, was 21.1 per 1000 live births. An increased risk of severe maternal morbidity was found in women aged ‡40 years and in those with low levels of education.Conclusions Nearly 70 000 maternal near-miss cases and approximately 750 000 cases with potentially life-threatening conditions are estimated to occur in Brazil per year. A pragmatic definition of maternal near miss was useful to obtain more reliable information at the community level. This approach could be used to gather information on maternal morbidity in settings in which such data are not routinely collected.

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Women's Reports of Severe (Near‐miss) Obstetric Complications in Benin

Cited by 88 publications

References 20 publications

Giving birth in maternity hospitals in Benin: Testimonies of women

Giving birth in maternity hospitals in Benin: Testimonies of women

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Maternal morbidity and near miss in the community: findings from the 2006 Brazilian demographic health survey

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