Severe maternal complications in near missed mothers in Shahid Mostafa Khomeini Hospital- Tehran: 2015-2019

Document Type : Original Article

Authors

1 Medical graduate, Faculty of Medicine, Shahed University, Tehran, Iran.

2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahed University, Tehran, Iran.

3 Assistant Professor, Department of Education, Faculty of Medicine, Shahed University, Tehran, Iran.

4 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahed University, Tehran, Iran.

Abstract

Introduction: To better evaluate the quality of midwifery care, an index called "near miss" mothers is used. The term refers to the mothers who have gone near to death due to complications of pregnancy or childbirth, but survived. This study was performed with aim to investigate the prevalence and causes of severe complications of maternal and near miss mothers.
Methods: This retrospective study was performed on patients' records in Shahid Mostafa Khomeini Hospital from 2015-2016. The required variables including demographic information and severe pregnancy complications were extracted from patients' records according to the instructions of the World Health Organization. Data were analyzed using SPSS statistical software (version 25) and paired chi-square and Mann-Whitney tests. P≤0.05 was considered statistically significant.
Results: Among 16,527 live births, 191 mothers suffered from severe maternal complications, of which 35 (17.3%) had near-miss and 2 maternal death. The ratio of near-miss mothers was 2.09 and the ratio of severe maternal complications was 11.40. The most important causes of severe complications were severe preeclampsia (n=134, 70.15%), severe obstetric bleeding (n=23, 12.4%) and sepsis (n=10, 5.23%). In cases of near-missed mothers, 19 cases (9.94%) had coagulation disorders, 9 (41.71%) had cardiovascular disorders, and 8 (4.18%) had kidney disorders. According to the results of logistic test, a significant relationship was found between anemia (p = 0.01) and severe preeclampsia (P = 0.006) in near-miss mothers and severe complications.
Conclusion: Essential delivery interventions including management of preeclampsia-eclampsia and its complications and the importance of maternal anemia during hospitalization play a vital role in reducing severe maternal complications.

Keywords


  1. Emamiafshar N, Jalilvand P, Delavar B, Radpouyan L, Azemikhah A, Valafar S. National maternal surveillance system. Tehran: Tandis Publication; 2006.
  2. Qiu L, Lin J, Ma Y, Wu W, Qiu L, Zhou A, et al. Improving the maternal mortality ratio in Zhejiang Province, China, 1988–2008. Midwifery 2010; 26(5):544-8.
  3. WHO U. UNFPA, The World Bank. Trends in maternal mortality: 1990 to 2008 Estimates developed by WHO, UNICEF. UNFPA and the World Bank. Geneva: World Health Organization; 2010.

4.        Rahimi S, Nejat S, Majdzadeh SR. Maternal mortality surveillance system: Attitude of health care staff and experts. Payesh (Health Monitor) 2012; 11(5):583-8.

  1. Zarei E, Khabiri R, Motlagh ME, Emami Afshar N, Rahimi A, Torkestani F, et al. Achieving of Iran to the Millennium Development Goal (MDG5) in maternal health. Hakim Health System Research 2017; 19(3):118-28.

6.        Ministry of Health and Medical Education .National Maternal Mortality Surveillance System; 2015. Available at: https://treatment.tbzmed.ac.ir7.        Cecatti JG, Souza JP, Parpinelli MA, de Sousa MH, Amaral E. Research on severe maternal morbidities and near-misses in Brazil: what we have learned. Reproductive health matters 2007; 15(30):125-33.

  1. Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. British medical bulletin 2003; 67(1):231-43.
  2. Domingues RM, Dias MA, Schilithz AO, do Carmo Leal M. Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011–2012. Reproductive health 2016; 13(3):187-97.
  3. Lobato G, Nakamura-Pereira M, Mendes-Silva W, Dias MA, Reichenheim ME. Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013; 167(1):24-8.
  4. Herklots T, Van Acht L, Meguid T, Franx A, Jacod B. Severe maternal morbidity in Zanzibar’s referral hospital: Measuring the impact of in-hospital care. PLoS One 2017; 12(8):e0181470.
  5. Say L, Souza JP, Pattinson RC. Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best practice & research Clinical obstetrics & gynaecology 2009; 23(3):287-96.
  6. World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health; 2011.
  7. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd New York: McGraw-Hill Education; 2018
  8. O’Malley EG, Popivanov P, Fergus A, Tan T, Byrne B. Maternal near miss: what lies beneath?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016; 199:116-20.
  9. De Mucio B, Abalos E, Cuesta C, Carroli G, Serruya S, Giordano D, et al. Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America. Reproductive health 2016; 13(1):1-10.
  10. Tunçalp Ö, Hindin MJ, Adu-Bonsaffoh K, Adanu RM. Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana. International Journal of Gynecology & Obstetrics 2013; 123(1):58-63.
  11. Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reproductive health 2004; 1(1):1-5.
  12. Cecatti JG, Souza JP, Neto AF, Parpinelli MA, Sousa MH, Say L, et al. Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss. Reproductive Health 2011; 8(1):1-7.
  13. World Health Organization. Quality of care: a process for making strategic choices in health systems. World Health Organization; 2006.‏
  14. Tunçalp Ö, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(6):653-61.
  15. Ghazivakili Z, Lotfi R, Kabir K, Naeeni MR. Maternal near miss approach to evaluate quality of care in Alborz province, Iran. Midwifery 2016; 41:118-24.
  16. Naderi T, Foroodnia S, Omidi S, Samadani F, Nakhaee N. Incidence and correlates of maternal near miss in Southeast Iran. International journal of reproductive medicine 2015; 2015.
  17. Mohammadi S. Beyond ‘Cesarean Overuse’: Hospital-Based Audits of Obstetric Care and Maternal Near Miss in Tehran, Iran (Doctoral dissertation, Acta Universitatis Upsaliensis); 2016.
  18. Mohammadi S, Essén B, Fallahian M, Taheripanah R, Saleh Gargari S, Källestål C. Maternal near‐miss at university hospitals with cesarean overuse: an incident case‐control study. Acta obstetricia et gynecologica Scandinavica 2016; 95(7):777-86.
  19. Jayaratnam S, Kua S, deCosta C, Franklin R. Maternal ‘near miss’ collection at an Australian tertiary maternity hospital. BMC pregnancy and childbirth 2018; 18(1):1-6.
  20. Souza JP, Cecatti JG, Faundes A, Morais SS, Villar J, Carroli G, et al. Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health. Bulletin of the World Health Organization 2010; 88:113-9.
  21. Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near-miss in a rural hospital in Sudan. BMC pregnancy and childbirth 2011; 11(1):1-4.
  22. Mohammadinia N, Samiezadeh Toosi T, Rezaei MA, Rostaei F. Investigating the frequency and effective factors on maternal mortality in Sistan and Baluchistan Province, Iran, 2002-2009. Iran J Obstet Gynecol Infertil 2013; 16(44):28-34.
  23. Almerie Y, Almerie MQ, Matar HE, Shahrour Y, Al Chamat AA, Abdulsalam A. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study. BMC pregnancy and childbirth 2010; 10(1):1-7.
  24. Galvão LP, Alvim-Pereira F, de Mendonça CM, Menezes FE, do Nascimento Góis KA, Ribeiro Jr RF, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC pregnancy and childbirth 2014; 14(1):1-8.
  25. Pacheco AJ, Katz L, Souza AS, de Amorim MM. Factors associated with severe maternal morbidity and near miss in the São Francisco Valley, Brazil: a retrospective, cohort study. BMC pregnancy and childbirth 2014; 14(1):1-8.
  26. Hashemi SN, Afshari P, Javadnoori M, Saki Malehi A. Prevalence and related factors of maternal severe complications “Maternal Near Miss” in Ahvaz, 2016. Iran J Obstet Gynecol Infertil 2020; 23(2):78-87.
  27. Khan T, Laul P, Laul A, Ramzan M. Prognostic factors of maternal near miss events and maternal deaths in a tertiary healthcare facility in India. International Journal of Gynecology & Obstetrics 2017; 138(2):171-6.
  28. Nelissen EJ, Mduma E, Ersdal HL, Evjen-Olsen B, van Roosmalen JJ, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study. BMC pregnancy and childbirth 2013; 13(1):1-0.
  29. Moudi Z, Arabnezhad L, Tabatabaei SM. Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study. Medical-Surgical Nursing Journal 2018; 7(3).
  30. Saleh Gargari S, Essén B, Fallahian M, Mulic‐Lutvica A, Mohammadi S. Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss. International Journal of Gynecology & Obstetrics 2019; 144(1):49-55.
  31. Abha S, Chandrashekhar S, Sonal D. Maternal near miss: A valuable contribution in maternal care. The Journal of Obstetrics and Gynecology of India 2016; 66(1):217-22.
  32. Liyew EF, Yalew AW, Afework MF, Essén B. Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa, Ethiopia. PloS one 2017; 12(6):e0179013.
  33. Jabir M, Abdul-Salam I, Suheil DM, Al-Hilli W, Abul-Hassan S, Al-Zuheiri A, et al. Maternal near miss and quality of maternal health care in Baghdad, Iraq. BMC pregnancy and childbirth 2013; 13(1):1-9.
  34. Abdillahi HA, Hassan KA, Kiruja J, Osman F, Egal JA, Klingberg‐Allvin M, et al. A mixed‐methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. International Journal of Gynecology & Obstetrics 2017; 138(1):119-24.
  35. Ashouri N, Kordi M, Shakeri MT, Tara F. Vaginal delivery postpartum hemorrhage: Incidence, risk factors, and causes. Iran J Obstet Gynecol Infertil 2019; 21(12):65-76.