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Severe acute maternal morbidity in low-income countries

https://doi.org/10.1016/j.bpobgyn.2009.01.001Get rights and content

Although obstetric complications are sometimes presented as a relatively easy alternative to maternal deaths, difficulties remain in their definition and identification, and there is limited experience with the use of severe obstetric complications as a starting point for audits or case reviews or as an indicator for monitoring the success of safe motherhood programmes in low-income countries. In this paper we review published studies reporting on the measurement of severe acute maternal morbidity in low-income countries. We found 37 studies from 24 countries. We describe the definition and ascertainment of cases of severe acute maternal morbidity and we give examples of how information on severe acute maternal morbidity has been used to inform safe motherhood programmes in low-income countries.

Section snippets

Methods

We searched Medline and reference lists for published studies reporting on severe acute maternal morbidity. Inclusion criteria were the use of clear pre-defined conditions for a range of severe obstetric morbidities, specified dates for data collection and a clear description of methods. Search terms included maternal morbidity, obstetric morbidity, near miss, severe acute maternal morbidity, life-threatening obstetric complications, unmet obstetric needs and developing countries. We excluded

Results

A total of 37 studies from 24 countries are included in this review, and a summary of all studies is presented in Table 1. All studies, except one7, were hospital-based studies. Two further population-based studies were excluded because no clear criteria of severity were given.8, 9

Conclusions

The measurement of acute severe maternal morbidity in populations with low access to obstetric care remains challenging. There are no standard criteria for the definition of acute severe morbidity and the incidence of severe acute maternal morbidity at the population level is largely unknown. An exception to this is the incidence of life-saving surgery, for which criteria have been standardised and comparable population-based data are becoming increasingly available. Whilst the reliance on

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