Obstetric near miss and deaths in public and private hospitals in Indonesia.
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This is the first study to document near miss in public and private hospitals in Indonesia; close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals.Abstract:
Falling numbers of maternal deaths have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The purpose of this study was to document the frequency and causes of near miss and maternal deaths in four hospitals in West Java, Indonesia. Cross sectional study in four hospitals in two districts in Banten province, Indonesia. We reviewed registers and case notes to identify the numbers and causes of near miss and death between November 2003 and October 2004. Near miss cases were defined based on organ dysfunction, clinical and management criteria. Near miss were categorized by whether or not the woman was at a critical state at admission by reviewing the final signs at admission. The prevalence of near miss was much greater in public than in private hospitals (17.3% versus 4.2%, p = 0.000). Hemorrhage and hypertensive diseases were the most common diagnoses associated with near miss, and vascular dysfunction was the most common criterion of organ dysfunction. The occurrence of maternal deaths was 1.6%, with non-obstetric complications as the leading cause. The majority (70.7%) of near miss in public hospitals were in a critical state at admission but this proportion was much lower in private hospitals (31.9%). This is the first study to document near miss in public and private hospitals in Indonesia. Close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals. Even though the private sector takes an increasingly larger share of facility-based births in Indonesia, managing obstetric emergencies remains the domain of the public sector.read more
Citations
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The prevalence of maternal near miss: a systematic review.
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References
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WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss)
TL;DR: There is a clear need to set uniform criteria to classify patients as SAMM and an organ-system dysfunction/failure approach is the most epidemiologically sound as it is least open to bias, and thus could permit developing summary estimates.
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Severe acute maternal morbidity: a pilot study of a definition for a near-miss
TL;DR: To test the application of a clinical definition of severe acute maternal morbidity, a large number of patients with confirmed or suspected cases of maternal death in the second trimester of pregnancy are randomly selected to undergo a EMT procedure.
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Obstetric patients requiring critical care. A five-year review.
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