Bashour Hyam, Saad-Haddad Ghada, DeJong Jocelyn, Ramadan Mohammed Cherine, Hassan Sahar, Breebaart Miral, Wick Laura, Hassanein Nevine, Kharouf Mayada
Faculty of Medicine, Damascus University, Damascus, Syria.
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
BMC Pregnancy Childbirth. 2015 Nov 13;15:296. doi: 10.1186/s12884-015-0733-7.
The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria.
We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection.
A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals.
Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high.
孕产妇接近死亡方法越来越多地被用作评估和改善孕产妇保健服务质量的工具。我们报告了一项由世界卫生组织（WHO）资助的实施研究形成阶段的结果，该研究旨在在设施层面收集埃及、黎巴嫩、巴勒斯坦和叙利亚四家主要公共转诊医院孕产妇接近死亡病例的患病率、特征及管理方面的原始数据。
我们从2011年开始在这四个地区对孕产妇接近死亡病例进行横断面研究，使用WHO表格（个人表格HRP A65661）收集四家研究医院严重孕产妇发病情况的数据。在每家医院，一个包括经过培训的医院医护人员在内的研究团队进行数据收集。
在数据收集期间，四个地区共报告了9063例活产分娩，共有77例严重孕产妇结局（71例孕产妇接近死亡病例和6例孕产妇死亡）。与巴勒斯坦的拉马拉医院和黎巴嫩的拉菲克·哈里里大学医院相比，埃及的加拉医院（8.6%）和叙利亚的达尔·陶利德医院（14.3%）这两家大型转诊医院的孕产妇死亡率指数更高。与使用相同数据收集工具的WHO多国调查相比，我们研究中的死亡率指数高于WHO调查中孕产妇死亡率中等国家的5.6%的指数。总体而言，在四家研究医院的孕产妇接近死亡病例中，出血相关并发症是最常见的情况。在所有医院，凝血功能障碍（76.1%）是孕产妇接近死亡病例中最普遍的功能障碍，其次是心血管功能障碍。在研究医院中，接近死亡的妇女接受关键循证干预的覆盖率普遍或非常高。
这一形成阶段的结果证实了进行质量改进干预的必要性。研究医院报告的主要临床干预措施的高覆盖率似乎与上述结果相矛盾，因为关键循证干预措施的覆盖水平很高。
