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PLoS One. 2012;7(8):e44129. doi: 10.1371/journal.pone.0044129. Epub 2012 Aug 29.

The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity.

Author information

1
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. souzaj@who.int

Erratum in

  • PLoS One. 2013;8(11). doi:10.1371/annotation/ca8ccfaa-71c2-4bb8-8b15-121af175a43f.

Abstract

OBJECTIVES:

To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments.

METHODS:

In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity.

RESULTS:

Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993)).

CONCLUSION:

The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.

PMID:
22952897
PMCID:
PMC3430678
DOI:
10.1371/journal.pone.0044129
[Indexed for MEDLINE]
Free PMC Article
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