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WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
References
WHO. Achieving Millennium development goal 5: target 5A and 5B on reducing maternal mortality and achieving universal access to reproductive health. Geneva: WHO reference number: WHO/RHR/09.06; 2009.
United Nations. 'The Millennium Development Goals Report 2015′ and 'Transforming our world: the 2030 agenda for sustainable development.' New york, 2015.
Souza JP, Gulmezoglu 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. 2013;381:1747–55.