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Open Access 01-12-2022 | Care | Research

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Authors: Obiageli Okafor, Nathalie Roos, Abdulfetah Abdulkadir Abdosh, Olubukola Adesina, Zaynab Alaoui, William Arriaga Romero, Bouchra Assarag, Olufemi Aworinde, Luc de Bernis, Rigoberto Castro, Hassan Chrifi, Louise Tina Day, Rahel Demissew, María Guadalupe Flores Aceituno, Luis Gadama, Biruck Gashawbeza, Sourou Goufodji Keke, Philip Govule, George Gwako, Kapila Jayaratne, Evelyne Béwendin Komboigo, Bredy Lara, Mugove Gerald Madziyire, Matthews Mathai, Rachid Moulki, Iatimad Moutaouadia, Stephen Munjanja, Carlos Alberto Ochoa Fletes, Edgar Ivan Ortiz, Henri Gautier Ouedraogo, Zahida Qureshi, Zenaida Dy Recidoro, Hemantha Senanayake, Priya Soma-Pillay, Khaing Nwe Tin, Pascal Sedami, Dawit Worku, Mercedes Bonet, on behalf of the WHO Global Maternal Sepsis Study- Maternal Death and Near-miss Review Working Group

Published in: BMC Pregnancy and Childbirth | Issue 1/2022

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Abstract

Background

Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement.

Method

An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework.

Results

Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections.

Conclusion

Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
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Literature
1.
go back to reference Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.PubMedCrossRef Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.PubMedCrossRef
2.
go back to reference Bonet M, Brizuela V, Abalos E, Cuesta C, Baguiya A, Chamillard M, et al. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health. 2020;8:e661–71.CrossRef Bonet M, Brizuela V, Abalos E, Cuesta C, Baguiya A, Chamillard M, et al. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health. 2020;8:e661–71.CrossRef
3.
go back to reference Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO multicountry survey on maternal and newborn health): a cross-sectional study. Lancet Lond Engl. 2013;381:1747–55.CrossRef Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO multicountry survey on maternal and newborn health): a cross-sectional study. Lancet Lond Engl. 2013;381:1747–55.CrossRef
5.
go back to reference Barton JR, Sibai BM. Severe Sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120:689–706.PubMedCrossRef Barton JR, Sibai BM. Severe Sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120:689–706.PubMedCrossRef
11.
go back to reference Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, et al. Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity. Southampton (UK): NIHR Journals Library; 2016. Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, et al. Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity. Southampton (UK): NIHR Journals Library; 2016.
14.
go back to reference Lewis G. Saving mothers’ lives: the continuing benefits for maternal health from the United Kingdom (UK) confidential enquires into maternal deaths. Semin Perinatol. 2012;36:19–26.PubMedCrossRef Lewis G. Saving mothers’ lives: the continuing benefits for maternal health from the United Kingdom (UK) confidential enquires into maternal deaths. Semin Perinatol. 2012;36:19–26.PubMedCrossRef
15.
go back to reference Dumont A, Fournier P, Abrahamowicz M, Traoré M, Haddad S, Fraser WD, et al. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet Lond Engl. 2013;382:146–57.CrossRef Dumont A, Fournier P, Abrahamowicz M, Traoré M, Haddad S, Fraser WD, et al. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet Lond Engl. 2013;382:146–57.CrossRef
20.
go back to reference Brizuela V, Cuesta C, Bartolelli G, Abdosh AA, Malham SA, Assarag B, et al. Availability of facility resources and services and infection-related maternal outcomes in the WHO global maternal Sepsis study: a cross-sectional study. Lancet Glob Health. 2021;9:e1252–61.PubMedPubMedCentralCrossRef Brizuela V, Cuesta C, Bartolelli G, Abdosh AA, Malham SA, Assarag B, et al. Availability of facility resources and services and infection-related maternal outcomes in the WHO global maternal Sepsis study: a cross-sectional study. Lancet Glob Health. 2021;9:e1252–61.PubMedPubMedCentralCrossRef
21.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.PubMedCrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.PubMedCrossRef
23.
go back to reference De Brouwere V, Zinnen V, Delvaux T. How to conduct maternal death reviews (MDR). Guidelines and tools for health professionals. London: International Federation of Gynecologists and Obstetricians; 2013. De Brouwere V, Zinnen V, Delvaux T. How to conduct maternal death reviews (MDR). Guidelines and tools for health professionals. London: International Federation of Gynecologists and Obstetricians; 2013.
25.
go back to reference Menéndez C, Quintó L, Castillo P, Fernandes F, Carrilho C, Ismail MR, et al. Quality of care and maternal mortality in a tertiary-level hospital in Mozambique: a retrospective study of clinicopathological discrepancies. Lancet Glob Health. 2020;8:e965–72.PubMedPubMedCentralCrossRef Menéndez C, Quintó L, Castillo P, Fernandes F, Carrilho C, Ismail MR, et al. Quality of care and maternal mortality in a tertiary-level hospital in Mozambique: a retrospective study of clinicopathological discrepancies. Lancet Glob Health. 2020;8:e965–72.PubMedPubMedCentralCrossRef
26.
go back to reference Braun V, Clarke V. Thematic analysis. In: APA handbook of research methods in psychology, Vol 2: research designs: quantitative, qualitative, neuropsychological, and biological. Washington, DC: American Psychological Association; 2012. p. 57–71.CrossRef Braun V, Clarke V. Thematic analysis. In: APA handbook of research methods in psychology, Vol 2: research designs: quantitative, qualitative, neuropsychological, and biological. Washington, DC: American Psychological Association; 2012. p. 57–71.CrossRef
27.
go back to reference Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.PubMedCrossRef Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.PubMedCrossRef
28.
go back to reference Cebekhulu S, Cornelissen L, Pattinson RC. Too little, too late : the recurrent theme in maternal deaths due to sepsis. Obstet Gynaecol Forum. 2018;28:9–12. Cebekhulu S, Cornelissen L, Pattinson RC. Too little, too late : the recurrent theme in maternal deaths due to sepsis. Obstet Gynaecol Forum. 2018;28:9–12.
30.
go back to reference Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486–552.PubMedCrossRef Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486–552.PubMedCrossRef
31.
go back to reference Greer O, Shah NM, Johnson MR. Maternal sepsis update: current management and controversies. Obstet Gynaecol. 2020;22:45–55.CrossRef Greer O, Shah NM, Johnson MR. Maternal sepsis update: current management and controversies. Obstet Gynaecol. 2020;22:45–55.CrossRef
32.
go back to reference Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, et al. Maternal complications and perinatal mortality: findings of the World Health Organization multicountry survey on maternal and newborn health. BJOG Int J Obstet Gynaecol. 2014;121:76–88.CrossRef Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, et al. Maternal complications and perinatal mortality: findings of the World Health Organization multicountry survey on maternal and newborn health. BJOG Int J Obstet Gynaecol. 2014;121:76–88.CrossRef
33.
go back to reference The Alliance for maternal and newborn health improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6:e1297–308.CrossRef The Alliance for maternal and newborn health improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6:e1297–308.CrossRef
34.
go back to reference Baguiya A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, et al. Perinatal outcomes among births to women with infection during pregnancy. Arch Dis Child. 2021;106:946–53.PubMedCrossRef Baguiya A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, et al. Perinatal outcomes among births to women with infection during pregnancy. Arch Dis Child. 2021;106:946–53.PubMedCrossRef
35.
go back to reference Bandali S, Thomas C, Hukin E, Matthews Z, Mathai M, Ramachandran Dilip T, et al. Maternal death surveillance and response systems in driving accountability and influencing change. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2016;135:365–71.CrossRef Bandali S, Thomas C, Hukin E, Matthews Z, Mathai M, Ramachandran Dilip T, et al. Maternal death surveillance and response systems in driving accountability and influencing change. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2016;135:365–71.CrossRef
37.
go back to reference van Hamersveld KT, den Bakker E, Nyamtema AS, van den Akker T, Mfinanga EH, van Elteren M, et al. Barriers to conducting effective obstetric audit in Ifakara: a qualitative assessment in an under-resourced setting in Tanzania. Tropical Med Int Health. 2012;17:652–7.CrossRef van Hamersveld KT, den Bakker E, Nyamtema AS, van den Akker T, Mfinanga EH, van Elteren M, et al. Barriers to conducting effective obstetric audit in Ifakara: a qualitative assessment in an under-resourced setting in Tanzania. Tropical Med Int Health. 2012;17:652–7.CrossRef
Metadata
Title
International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions
Authors
Obiageli Okafor
Nathalie Roos
Abdulfetah Abdulkadir Abdosh
Olubukola Adesina
Zaynab Alaoui
William Arriaga Romero
Bouchra Assarag
Olufemi Aworinde
Luc de Bernis
Rigoberto Castro
Hassan Chrifi
Louise Tina Day
Rahel Demissew
María Guadalupe Flores Aceituno
Luis Gadama
Biruck Gashawbeza
Sourou Goufodji Keke
Philip Govule
George Gwako
Kapila Jayaratne
Evelyne Béwendin Komboigo
Bredy Lara
Mugove Gerald Madziyire
Matthews Mathai
Rachid Moulki
Iatimad Moutaouadia
Stephen Munjanja
Carlos Alberto Ochoa Fletes
Edgar Ivan Ortiz
Henri Gautier Ouedraogo
Zahida Qureshi
Zenaida Dy Recidoro
Hemantha Senanayake
Priya Soma-Pillay
Khaing Nwe Tin
Pascal Sedami
Dawit Worku
Mercedes Bonet
on behalf of the WHO Global Maternal Sepsis Study- Maternal Death and Near-miss Review Working Group
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Care
Published in
BMC Pregnancy and Childbirth / Issue 1/2022
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-022-04731-x

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