Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
BMC Pregnancy Childbirth. 2011 Sep 28;11:65. doi: 10.1186/1471-2393-11-65.
Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa.
We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments). We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated.
We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals), others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72.7%.
The incidence/prevalence ratio and case fatality ratio of maternal near misses are very high in studies from sub-Saharan Africa. Large differences exist between countries on the prevalence/incidence of maternal near misses. This could be due to different contexts/settings, variation in the criteria used to define the maternal near misses morbidity, or rigor used carrying out the study. Future research on maternal near misses should adopt the WHO recommendation on classification of maternal morbidity and mortality.
严重产妇发病率（产妇濒死）分析提供了有关护理质量的信息。我们通过对撒哈拉以南非洲严重产妇发病率的研究进行系统回顾，评估了产妇发病率、产妇死亡率和病死率。
我们检查了 1996 年至 2010 年期间报告的妊娠、分娩和产后期间严重产妇发病率（产妇濒死）发生率/发病率的研究。我们评估了研究的质量（目标、研究设计、研究人群、研究地点和背景、严重急性产科发病率的定义和数据收集工具）。我们使用预定义的方案和标准提取数据，并估计了产妇发病率的发生率/发病率。报告的产妇并发症的病死率也进行了估计。
我们确定了 12 项研究：6 项为横断面研究，5 项为前瞻性研究，1 项为医疗记录的回顾性研究。研究地点存在差异：有些研究是基于医疗机构（国家转诊医院、区域医院或各种地区医院），而其他研究是基于社区的研究。样本量从 557 名妇女到 23026 名妇女不等。产妇发病率的定义和术语各不相同，包括急性产科并发症、严重危及生命的产科并发症和严重产科并发症。产妇发病率的发生率/发病率和病死率范围分别为 1.1%-10.1%和 3.1%-37.4%。破裂的子宫、败血症、产程梗阻和出血是最常见的分析性疾病。出血的发生率/发病率范围为 0.06%至 3.05%，而出血的病死率范围为 2.8%至 27.3%。败血症的发生率/发病率范围为 0.03%至 0.7%，而病死率范围为 0.0%至 72.7%。
撒哈拉以南非洲的研究中，产妇发病率的发生率/发病率和病死率非常高。各国之间在产妇发病率方面存在很大差异。这可能是由于不同的背景/环境、用于定义产妇发病率发病率的标准的差异，或进行研究的严谨性不同。未来的产妇发病率研究应采用世卫组织关于孕产妇发病率和死亡率分类的建议。
