Abstract
BackgroundThe reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality.MethodsA systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used.ResultsAfter the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%).ConclusionsThe Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage.Trial registrationPROSPERO ID: CRD 42019133464
Highlights
The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss
Over 90% of the studies were led by different authors; among those who led in publishing, the author who published the most studies in the period included in this analysis of maternal near miss (MNM) was Jayaratnam, with four
Brazil published the most studies in this period, followed by India, Nigeria and Ethiopia; most studies were published in low-Human Development Index (HDI) countries, leading to publication bias because, as this study shows, cases of severe maternal morbidity are more prevalent in more disadvantaged countries
Summary
The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. One of the Millennium Development Goals set in 2000 by the member countries of the United Nations is to improve the health of women through multiple interventions, such as promoting access to family planning services and emergency obstetric care by qualified and trained personnel. In this respect, women in low-income countries are especially vulnerable to dying from obstetric causes. In 2017-2019, the Quality of Care Network group supported by the WHO included more countries – such as Ethiopia, Ghana, India, Malawi, Nigeria, Tanzania and Uganda – on its agenda to complete the following tasks:
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