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Developing an assessment tool for maternal morbidity 'near-miss'- a prospective study in a large Australian regional
Skandarupan Jayaratnam1, Caroline De Costa, Paul Howat
1Department of Obstetrics and Gynaecology, Cairns Base Hospital, Queensland, Australia.
Background:
Maternal mortality is now a rare event in the developed world and its measurement is no longer a useful way of assessing obstetric care. Examination of cases of women who nearly died but survived a severe complication of pregnancy or childbirth - maternal 'near-misses' - is increasingly being recognised as potentially more useful, although severe maternal morbidity is much less easy to define and quantify than maternal death.
Aim:
To identify and assess prospectively cases of severe maternal morbidity presenting to Cairns Base Hospital (CBH), to define cases as near-misses and thereby develop a tool for future assessment of obstetric care in CBH and elsewhere.
Methods:
Based on approaches recommended by the recent WHO working group on Maternal Mortality and Morbidity classifications, a data collection form was constructed using a combination of named morbidities and specific interventions. Over 1 year data from all cases of severe maternal morbidity was collected and analysed both prospectively and retrospectively to identify true near-misses.
Results:
Seventeen cases of true near-misses were identified, giving a near-miss rate of six per 1000 live births for CBH in the study period; 64% of cases were attributable to obstetric causes and 36% to non-obstetric causes.
Conclusions:
Collection of near-miss data has the potential to become a useful tool for the assessment of obstetric care in both in CBH and in other Australian hospitals but is time-consuming and requires continuous surveillance by medical staff if cases are not to be overlooked.
