- Critical cases of maternal mortality – a severe obstetrical complication, reflecting the quality of medical services provided
Critical cases of maternal mortality – a severe obstetrical complication, reflecting the quality of medical services provided
HEALTH OF WOMAN. 2017.9(125):27–30; doi 10.15574/HW.2017.125.27
Dondyuk Yu. V.
State University of Medicine and Pharmacy. Nicholas Testemitanu, Chisinau, Republic of Moldova
Maternal near miss and maternal death audit has become an esssential process in the context of obstetric care in both developed and developing countries.
The objective: of the present study was to assess the quality of medical services provided within the multilevel regionalized Perinatal Health System in the Republic of Moldova, by identifying the inconsistencies with existing standards of medical care, in cases of severe obstetric complications and maternal deaths.
Materials and methods. All cases of maternal near miss cases and maternal deaths recorded in the Secondary and Tertiary Perinatal Centers of the Republic of Moldova during the period 2009–2014 were analyzed retrospectively. To assess the quality of obstetric care, the following indices have been calculated: maternal near miss/ maternal deaths ratio; the mortality index for each obstetric condition/ complication.
Results. During a period of 6 years, in 11 Secondary and Tertiary Perinatal Centers of the Republic of Moldova there were registered 154 651 births, 2881 cases of maternal near miss and 21 maternal deaths. The General Mortality index was 0.72%, and the Mortality Index by direct obstetric morbidity was 0.48%. 92.86% of maternal deaths through direct obstetric causes were avoidable, and the proportion of near miss cases with substandard care was 81.85%. The most frequent gaps (82.48%) were caused by human factors, such as insufficient team work, communication deficiency, lack of knowledge and clinical skills necessary to properly recognize and treat critical obstetric patients, delay and errors in diagnosis and treatment, non-compliance with clinical protocols.
Conclusions. The excessively high proportion of avoidable factors highlighted in the study is alarming and implies the need for more extensive activities and the development of strategies focused on ensuring the presence of qualified medical workers in medical institutions, which will allow the provision of qualitative care and safety for patients in the Republic of Moldova, reducing maternal morbidity and mortality.
Key words: severe maternal morbidity, maternal near miss, maternal death, maternal mortality.
1. Abouchadi S, Alaoui A, Meski Z, Bezad R, De Brouwere V. 2013. Preventable maternal mortality in Morocco: the role of hospitals. Tropical Medicine and International Health. 18;4:444–450. https://doi.org/10.1111/tmi.12065
2. Almerie Y, Almerie M, Matar H, Shahrour Y, Al Chamat A, Abdulsalam A. 2010. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study. BMC Pregnancy and Childbirth. 10:65. http://www.biomedcentral.com/1471-2393/10/65. https://doi.org/10.1186/1471-2393-10-65; PMid:20959012 PMCid:PMC2973846
3. Bewley S, Wolfe C, Waterstone M. 2002. Severe morbidity in the UK. In: MacLean AB, Neilson JP (eds) Maternal Morbidity and Mortality. London, RCOG Press.: 132–46.
4. Farquhar C, Sadler L, Masson V, Bohm G, Haslam A. 2011. Beyond the numbers: classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006–2009. Am J. Obstet. Gynecol. 205(4):331.e1-331.e8. https://doi.org/10.1016/j.ajog.2011.07.044
5. Merali HS, Lipsitz S, Hevelone N, Gawande AA, Lashoher A, Agrawal P et al. 2014. Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childbirth. 14:280. https://doi.org/10.1186/1471-2393-14-280.
6. Minkauskiene M, Nadisauskiene R, Padaiga Z, Makari S. 2004. Systematic review on the incidence and prevalence of severe maternal morbidity. Medicina (Kaunas) 40(4):299–309.
7. Mkandawire C. 2010. Near miss maternal morbidity at the University Teaching Hospital, Lusaka – a descriptive study. Dissertation for the degree of master of medicine in obstetrics and gynecology. The University of Zambia, Scool of Medicine: 69. http://hdl.handle.net/123456789/1051
8. Oladapo O, Sule-Odu A, Olatunji A, Daniel O. 2005. «Near-miss» obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod. Health 2:9. https://doi.org/10.1186/1742-4755-2-9; PMid:16262901 PMCid:PMC1291401
9. Pattinson RC, Hall M. 2003. Near misses: a useful adjunct to maternal death enquiries. Br. Med. Bull. 67:231–43. https://doi.org/10.1093/bmb/ldg007
10. Roopa PS, Shailja Verma, Lavanya Rai, Pratap Kumar, Murlidhar V Pai, Jyothi Shetty. 2013. “Near Miss” Obstetric Events and Maternal Deaths in a Tertiary Care Hospital: An Audit. Journal of Pregnancy. Volume 2013:5. Article ID 393758. http://dx.doi.org/10.1155/2013/393758
11. Rozina M, Hashmi H. 2009. Near-miss obstetrical events and maternal deaths. Journal of the College of Physicians and Surgeons Pakistan. 19(12):781–785.
12. Say L, Souza JP, Pattinson RC. 2009. WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract. Res. Clin. Obstet. Gynecol. 23(3):287–96. https://doi.org/10.1016/j.bpobgyn.2009.01.007; PMid:19303368
13. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A, Daniels J, Gülmezoglu A, Temmerman M, Alkema L. 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2(6):e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X
14. Taly A, Gupta Sh, Jain N. 2004. Maternal intensive care and near-miss mortality in obstetrics. J. Obstet. Gynecol. Ind. 54(5):478–482.
15. Vandecruys H, Pattinson RC, Macdonald AP, Mantel GD. 2002. Severe acute maternal morbidity and mortality in the Pretoria Academic Complex: changing patterns over four years. Eur. J. Obstet. Gynaecol. Reprod. Biol. 102(1):6–10. https://doi.org/10.1016/S0301-2115(01)00558-9
16. Waterstone M, Bewley S, Wolfе Ch. 2001. Incidence and predictors of severe obstetric morbidity: case-control study Commentary: Obstetric morbidity data and the need to evaluate thromboembolic disease. BMJ. 322:1089.
17. www.cnms.md Rapoarte – Evoluюia sistemului de sгnгtate din Republica Moldova оn perioada guvernгrii coaliюiei proeuropene, anii 2009–2014.