School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Obstetrics and Gynaecology (CB20), University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, Netherlands.
BMC Pregnancy Childbirth. 2017 Dec 29;17(1):445. doi: 10.1186/s12884-017-1640-x.
Assessments of maternal near miss (MNM) are increasingly used in addition to those of maternal mortality measures. The World Health Organization (WHO) has introduced an MNM tool in 2009, but this tool was previously found to be of limited applicability in several low-resource settings. The aim of this study was to identify adaptations to enhance applicability of the WHO MNM tool in sub-Saharan Africa.
Using a Delphi consensus methodology, existing MNM tools were rated for applicability in sub-Saharan Africa over a series of three rounds. Maternal health experts from sub-Saharan Africa or with considerable knowledge of the context first rated importance of WHO MNM parameters using Likert scales, and were asked to suggest additional parameters. This was followed by two confirmation rounds. Parameters accepted by at least 70% of the panel members were accepted for use in the region.
Of 58 experts who participated from study onset, 47 (81%) completed all three rounds. Out of the 25 WHO MNM parameters, all 11 clinical, four out of eight laboratory, and four out of six management-based parameters were accepted, while six parameters (PaO2/FiO2 < 200 mmHg, bilirubin >100 μmol/l or >6.0 mg/dl, pH <7.1, lactate >5 μmol/l, dialysis for acute renal failure and use of continuous vasoactive drugs) were deemed to not be applicable. An additional eight parameters (uterine rupture, sepsis/severe systemic infection, eclampsia, laparotomy other than caesarean section, pulmonary edema, severe malaria, severe complications of abortions and severe pre-eclampsia with ICU admission) were suggested for inclusion into an adapted sub-Saharan African MNM tool.
All WHO clinical criteria were accepted for use in the region. Only few of the laboratory- and management based were rated applicable. This study brought forward important suggestions for adaptations in the WHO MNM criteria to enhance its applicability in sub-Saharan Africa and possibly other low-resource settings.
除了对孕产妇死亡率进行评估外，目前越来越多地对孕产妇严重发病进行评估。世界卫生组织（WHO）于 2009 年推出了孕产妇严重发病工具，但此前发现该工具在一些资源匮乏的环境中的适用性有限。本研究旨在确定适应能力，以增强该工具在撒哈拉以南非洲的适用性。
使用德尔菲共识方法，对现有的孕产妇严重发病工具进行了一系列三轮的适用性评估。来自撒哈拉以南非洲的孕产妇健康专家或对该地区有丰富了解的专家首先使用李克特量表对 WHO 孕产妇严重发病参数的重要性进行评分，并被要求提出其他参数。随后进行了两轮确认。至少有 70%的专家组成员接受的参数被接受在该地区使用。
从研究开始就有 58 名专家参与，其中 47 名（81%）完成了所有三轮。在 25 个 WHO 孕产妇严重发病参数中，所有 11 个临床参数、8 个实验室参数中的 4 个、6 个管理参数中的 4 个被接受，而 6 个参数（PaO2/FiO2 < 200mmHg、胆红素>100μmol/L 或>6.0mg/dl、pH <7.1、乳酸>5μmol/L、急性肾功能衰竭透析和使用连续血管活性药物）被认为不适用。另外还提出了 8 个参数（子宫破裂、脓毒症/严重全身感染、子痫、除剖宫产外的剖腹手术、肺水肿、严重疟疾、流产严重并发症和严重子痫伴有 ICU 入院），建议纳入适应撒哈拉以南非洲的孕产妇严重发病工具。
WHO 的所有临床标准都被接受在该地区使用。只有少数实验室和管理标准被认为适用。本研究为适应 WHO 孕产妇严重发病标准提出了重要建议，以增强其在撒哈拉以南非洲和其他资源匮乏地区的适用性。
