Care assessment's difficult relation with maternal mortality

摘要

The notion that severe maternal outcomes (SMOs) should be reduced by the essential interventions (eg, prophylactic or therapeutic uterotonic and magnesium sulphate for eclampsia) that have been promoted extensively in the past 10 years by various UN agencies is widely accepted. However, quantification of rates of SMO around the world is challenging because of different definitions in use. In the WHO Multicountry Survey on Maternal and Newborn Health, published in The Lancet, Joao Paulo Souza and colleagues1 have produced a definition of SMO, including near-miss events, and have undertaken a large international survey to assess the effects of essential interventions on maternal outcomes. Their cross-sectional study took place in 357 health-care facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. 314623 women who delivered in the participating hospitals or were admitted for a complication of the first trimester of pregnancy were included. 23015 (7%) of these women had potentially life-threatening conditions and 3024 (about 1%) developed an SMO, including 2538 near-miss cases (0-8%). Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women with an SMO. Comparing expected and observed case fatality rates, termed the maternal severity index, provided a reliable indicator of health-care performance.