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The Cardio-Obstetric Team
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The concept of team effort to care for a patient is not novel, especially when there is a high risk of morbidity and mortality. The goal is to bring together skill sets from maternal-fetal medicine (MFM), cardiology, anesthesia, neonatology, and other subspecialties as needed to optimize patient care. Cardiovascular disease in pregnancy is the number one indirect obstetric cause of pregnancy-related mortality ratio in the United States [1]. The 2006–2010 pregnancy-related mortality ratio was 16.0 deaths per 100,000 live births, a total of 14.6% due to cardiovascular conditions and 11.8% due to cardiomyopathy [1]. Improved data collection of severe maternal morbidity and maternal near-miss (SMM/MNM) has illustrated that cardiac disease is a significant contributing indicator in the United States [2]. The definition of SMM/MNM has evolved from the initial WHO definition that attempted to establish a comparable description across facilities to encourage health quality improvement [13]. The 2011 SMM/MNM definition includes five disease-specific, four management, and seven organ dysfunction−based criteria including cardiovascular dysfunction. In the United States, the Centers for Disease Control and Prevention (CDC) uses a large all-payer hospital inpatient care database for SMM/MNM surveillance. These indicators are based on three guiding principles [3]: State-level availability of data in most states, territories, and large metropolitan areasPresence of an established evidence base in the literatureQuality of the indicator was sufficient for population level surveillance and the planning and evaluation of public health interventions
Socio-behavioural determinants of maternal near miss: a prospective case control study from a tertiary care centre of India
Published in Journal of Obstetrics and Gynaecology, 2022
Neha Agarwal, Vanita Jain, Rashmi Bagga, Pooja Sikka, Seema Chopra, Kajal Jain, Tanuja Muthyala
Maternal morbidity and mortality are still a burden in a developing country like India. Despite making tremendous progress in the obstetric care facilities at a tertiary level, there are still challenges to make pregnancy completely safe. In our study, we found that ‘delays’ were the most significant determinants of maternal near miss. There was delay in seeking care, delay in reaching first and final place of care and finally delay in making a diagnosis which significantly contributed to near miss. Lack of knowledge, non-availability of the decision maker, and concern of cost of transport were the main contributors of these delays. Based upon the results of our study, it can be concluded that any pregnancy can lead to obstetric complication if not supervised and intervened at appropriate time. Majority of the cases of near miss were attributed to poor utilisation of health resources, ignorance and lack of emergency obstetric care at the primary level.
Maternal near miss: reaching the last mile
Published in Journal of Obstetrics and Gynaecology, 2021
WHO MNM criteria is the most frequently used (Say et al. 2009, 2004) and involves three approaches to identify MNM cases, namely disease specific, intervention based and organ system dysfunction based. There are 11 clinical, 8 laboratory based and 6 management-based criteria; a total of 25. According to this criteria, a woman presenting with any of the following life-threatening conditions and surviving a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy should be considered as a maternal near miss case
Too busy to care? Analysing the impact of system-related factors on maternal mortality in Zanzibar’s Referral Hospital
Published in Journal of Obstetrics and Gynaecology, 2022
Eline D. Veenstra, Tanneke Herklots, Khairat Said Mbarouk, Tarek Meguid, Arie Franx, Benoit Jacod
Although these factors are known to be prevalent in cases of maternal death, their true contribution to the mortality burden is unclear as they are most likely to be also present in women that did survive severe complications. If adequately selected, maternal near-miss cases are very similar to maternal mortality cases and can be used to quantify this contribution (Herklots et al. 2019).