Maternal mortality: near-miss events in middle-income countries, a systematic review
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Authors
Heitkamp, Anke; Meulenbroek, Anne; van Roosmalen, Jos; Gebhardt, Stefan; Vollmer, Linda;de Vries, Johanna I;Theron, Gerhard;van den Akker, Thomas
Issue Date
2021
Type
Journal / periodical articles
Language
Keywords
Maternal mortality;Systematic Reviews
Alternative Title
Abstract
Description
Objective: To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health
Organization’s (WHO) maternal near-miss tool and to evaluate its applicability in these settings.
Methods: We did a systematic review of studies on maternal near misses in middle-income countries published over 2009–2020. We
extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ
dysfunction. We extracted, or calculated, the maternal near-miss ratio, maternal mortality ratio and mortality index. We also noted descriptions
of researchers’ experiences and modifications of the WHO tool for local use.
Findings: We included 69 studies from 26 countries (12 lower-middle- and 14 upper-middle-income countries). Studies reported a total
of 50 552 maternal near misses out of 10 450 482 live births. Median number of cases of maternal near miss per 1000 live births was 15.9
(interquartile range, IQR: 8.9–34.7) in lower-middle- and 7.8 (IQR: 5.0–9.6) in upper-middle-income countries, with considerable variation
between and within countries. The most frequent causes of near miss were obstetric haemorrhage in 19/40 studies in lower-middleincome countries and hypertensive disorders in 15/29 studies in upper-middle-income countries. Around half the studies recommended
adaptations to the laboratory and management criteria to avoid underestimation of cases of near miss, as well as clearer guidance to avoid
different interpretations of the tool.
Conclusion: In several countries, adaptations of the WHO near-miss tool to the local context were suggested, possibly hampering international
comparisons, but facilitating locally relevant audits to learn lessons.
Citation
Publisher
WHO
License
CC BY-NC-SA 3.0 IGO