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Maternal near miss – towards a standard tool for monitoring quality of maternal health care

https://doi.org/10.1016/j.bpobgyn.2009.01.007Get rights and content

Maternal mortality is still among the worst performing health indicators in resource-poor settings. For deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system and take corrective action. However, although a significant public health problem, maternal deaths are rare in absolute numbers especially within an individual facility. Studying cases of women who nearly died but survived a complication during pregnancy, childbirth or postpartum (maternal near miss or severe acute maternal morbidity) are increasingly recognized as useful means to examine quality of obstetric care. Nevertheless, routine implementation and wider application of this concept in reviewing clinical care has been limited due to the lack of a standard definition and uniform case-identification criteria. WHO has initiated a process in agreeing on a definition and developing a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases for monitoring and improving quality of obstetric care. A list of identification criteria was proposed together with one single definition. This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health.

Section snippets

Terminology and definition

“Near miss” and “severe acute maternal morbidity - SAMM” are the two terms used interchangeably for a “severe, life-threatening obstetric complication.” Borrowed from the airline industry, “near miss” in health care literature generally describes a condition that did not result in injury, illness, or damage - but had the potential to do so.15 However, in the context of maternal health, the near miss term has been historically used referring to a condition where a woman experienced a severe

Identification of maternal near miss cases

The next step is to define a set of criteria with which “a woman who nearly died but survived a complication” or a maternal near miss case can be identified. The criteria selected must be locally usable and relevant 18 while allowing comparisons between different sites, areas or ideally countries. There are three main approaches to select cases that would qualify as a maternal near miss. These are described in Table 1.

As discussed within the WHO systematic review of maternal near miss, each of

Summary and conclusions

Maternal mortality is among the worst performing health indicators in resource-poor settings despite increased global attention for its reduction. For those deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system. Maternal death reviews, if implemented consistently, could provide valuable information. However, although a significant public health problem, maternal deaths still are

Acknowledgements

The following individuals were among the members of the WHO working group that developed the identification criteria for maternal near miss (Affette McCaw-Binns, Ahmet Metin Gulmezoglu, Anoma Jayathilaka, Buyanjargal Yadamsuren, Cleone Rooney, João Paulo Souza, Jon Barrett, José Guilherme Cecatti, Lale Say, Linda Bartlett, Mary Ellen Stanton, Mohamed Cherine Ramadan, Nynke van den Broek, Robert C Pattinson, Rogelio Gonzalez, Veronique Filippi). We thank Jelka Zupan, Joaquin G Gomez Davila, and

References (25)

  • L. Cochet et al.

    Severe acute maternal morbidity and maternal death audit–a rapid diagnostic tool for evaluating maternal care

    South Afr Med J

    (2003)
  • R.C. Pattinson et al.

    Why do women die during childbirth

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    Disclaimer: The views expressed in this document are solely the responsibility of the authors and do not necessarily represent the views of the World Health Organization or its member countries.

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