The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity

• Published in: PloS one 2012-08, Vol.7 (8), p.e44129-e44129
• Main Authors: Souza, Joao Paulo, Cecatti, Jose Guilherme, Haddad, Samira M, Parpinelli, Mary Angela, Costa, Maria Laura, Katz, Leila, Say, Lale
• Format: Article
• Language: English
• Subjects: Benchmarks; Biomarkers - metabolism; Brazil - epidemiology; Complications; Criteria; Data collection; Diagnostic systems; Fatalities; Female; Gynecology; Health aspects; Health care facilities; Health services; Health surveillance; Hospital facilities; Humans; Identification; Intensive care; Likelihood ratio; Management; Maternal & child health; Maternal Death - statistics & numerical data; Maternal health services; Maternal mortality; Medicine; Models, Biological; Morbidity; Obstetrics; Preeclampsia; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Pregnancy Complications - mortality; Public health; Regression models; Reproductive health; Statistical analysis; Womens health; Working groups; World Health Organization
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0044129

To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993)). The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.