SynthesisBulletin of the World Health Organization2021
Maternal mortality: near-miss events in middle-income countries, a systematic review.
Synthesis in Bulletin of the World Health Organization, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Maternal near miss incidence ratio, its causes and risk factors in East Africa: a systematic review and meta-analysis.Reproductive health · 2025Pooled it
- Maternal mortality: near-miss events in middle-income countries, a systematic review.Bulletin of the World Health Organization · 2021Pooled it
- Dynamic analysis of critical maternal complications in tertiary hospitals in Wuxi: A study based on four years of monitoring data.PloS one · 2026Article
- Pregnancy and postpartum-related admissions to the intensive care unit at a tertiary centre in Northwest China: a 14-year retrospective study.BMC pregnancy and childbirth · 2025Article
- Systolic hypertension, caesarean duration and prenatal visits as predictors of maternal near miss in Peru.International health · 2025Article
- Clinical Profile, Risk Factor Stratification and Outcomes of the Fernandez Birth Cohort from India: A Decade of Experience.Journal of obstetrics and gynaecology of India · 2025Article
- Evaluating Maternal Healthcare Quality Through the Lens of Maternal near Miss: A Retrospective Analysis from a High-Volume Tertiary Center.Medicina (Kaunas, Lithuania) · 2025Article
- Trends and adverse pregnancy outcomes associated with preeclampsia: a multi-centre cross-sectional study in Hebei, China.BMC pregnancy and childbirth · 2025Article
- Article
- Analysis of cases of near misses in obstetric-gynaecological practice.Archives of gynecology and obstetrics · 2025Review
- Women's experiences of high-risk pregnancy care in resource constrained Cape Town communities.Health SA = SA Gesondheid · 2025Article
- Pregnancy complications associated with maternal near-miss in an undeveloped province in south-central China, 2012-2022.BMC public health · 2024Article
- Risk factors for maternal near-miss in an undeveloped province in south-central China, 2012-2022.BMC public health · 2024Article
- Observational
- Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study.The Lancet. Digital health · 2024Article
- Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population-based cohort analysis during 2014-2019 using the national electronic healthcare system.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Predicting severe maternal outcomes in a network of sentinel sites in Latin-American countries.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2023Observational
- "There is no joy in the family anymore": a mixed-methods study on the experience and impact of maternal mortality on families in Ghana.BMC pregnancy and childbirth · 2022Article
- Indicators for maternal near miss: an observational study, India.Bulletin of the World Health Organization · 2022Observational
- Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries.PLOS global public health · 2022Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and to evaluate its applicability in these settings.
methodsWe did a systematic review of studies on maternal near misses in middle-income countries published over 2009-2020. We extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ dysfunction. We extracted, or calculated, the maternal near-miss ratio, maternal mortality ratio and mortality index. We also noted descriptions of researchers' experiences and modifications of the WHO tool for local use.
findingsWe included 69 studies from 26 countries (12 lower-middle- and 14 upper-middle-income countries). Studies reported a total of 50 552 maternal near misses out of 10 450 482 live births. Median number of cases of maternal near miss per 1000 live births was 15.9 (interquartile range, IQR: 8.9-34.7) in lower-middle- and 7.8 (IQR: 5.0-9.6) in upper-middle-income countries, with considerable variation between and within countries. The most frequent causes of near miss were obstetric haemorrhage in 19/40 studies in lower-middle-income countries and hypertensive disorders in 15/29 studies in upper-middle-income countries. Around half the studies recommended adaptations to the laboratory and management criteria to avoid underestimation of cases of near miss, as well as clearer guidance to avoid different interpretations of the tool.
conclusionIn several countries, adaptations of the WHO near-miss tool to the local context were suggested, possibly hampering international comparisons, but facilitating locally relevant audits to learn lessons.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.