Harvard T. H Chan School of Public Health, Boston, MA, USA.
Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2022 May 23;22(1):431. doi: 10.1186/s12884-022-04731-x.
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.
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.
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.
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.
产科感染是导致产妇死亡的第三大常见原因，在中低收入国家（LMICs）负担最重。我们分析了感染相关产妇死亡和接近死亡病例的原因，确定了促成因素，并提出了改进护理质量的建议措施。
对在至少有一例 GLOSS 研究死亡病例的 11 个 LMICs 的 15 家卫生机构报告的产妇死亡和接近死亡病例进行了国际虚拟机密调查。将医疗机构病历和当地审查委员会文件中有关产妇特征、时间和事件链、病例管理、结局以及医疗机构特征的信息汇总为每位妇女的病例报告，并由国际外部审查委员会进行审查。确定了可改变的因素，并使用三个延迟框架组织了建议措施。
国际外部审查委员会在 20 次虚拟会议上审查了 13 例感染相关产妇死亡和 19 例接近死亡病例。在审查过程中确定了 151 个可改变的因素，在产妇死亡中，护理延迟导致 71/85 个可改变因素，在接近死亡病例中，护理延迟导致 55/66 个可改变因素。到达 GLOSS 机构的延迟导致 5/85 和 1/66 个可改变因素分别为产妇死亡和接近死亡病例。与接近死亡病例的三个可改变因素相比，产妇死亡的两个可改变因素与寻求护理的决策延迟有关。抗生素使用不当、错过微生物培养和其他实验室结果、不正确的工作诊断以及住院期间监测不频繁是导致产妇死亡和接近死亡病例护理延迟的主要原因。对 2/13 例产妇死亡和 0/19 例接近死亡病例进行了当地机构审计。根据审查结果，外部审查委员会建议采取行动，以改善感染的预防和管理，从而预防和控制 LMICs 中与感染相关的严重产妇结局。产妇死亡和接近死亡病例审查的接受率低表明医疗机构团队错过了学习机会。虚拟平台为改善当地机密产妇死亡和接近死亡病例审查的常规采用提供了可行的解决方案。
