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. 2016 Mar 2:16:45.
doi: 10.1186/s12884-015-0789-4.

Constructing maternal morbidity - towards a standard tool to measure and monitor maternal health beyond mortality

Doris Chou  1 , Özge Tunçalp  2 , Tabassum Firoz  3 , Maria Barreix  4 , Veronique Filippi  5 , Peter von Dadelszen  6 , Nynke van den Broek  7 , Jose Guilherme Cecatti  8 , Lale Say  9 ; Maternal Morbidity Working Group
Affiliations

Constructing maternal morbidity - towards a standard tool to measure and monitor maternal health beyond mortality

Doris Chou et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal morbidity is a complex entity and its presentation and severity are on a spectrum. This paper describes the conceptualization and development of a definition for maternal morbidity, and the framework for its measurement: the maternal morbidity matrix, which is the foundation for measuring maternal morbidity, thus, the assessment tool.

Discussion: We define maternal morbidity and associated disability as "any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's wellbeing and/or functioning." A matrix of 121 conditions was generated through expert meetings, review of the International Classification of Diseases and related health problems (ICD-10), literature reviews, applying the definition of maternal morbidity and a cut-off of >0.1% prevalence. This matrix has three dimensions: identified morbidity category, reported functioning impact and maternal history. The identification criteria for morbidity include 58 symptoms, 29 signs, 44 investigations and 35 management strategies; these criteria are aimed at recognizing the medical condition, or the functional impact/disability component that will capture the negative impact experienced by the woman. The maternal morbidity matrix is a practical framework for assessing maternal morbidity beyond near-miss. In light of the emerging attention to Universal Health Coverage (UHC) as part of the post-2015 Sustainable Development Goals (SDGs) planning, a definition and standard identification criteria are essential to measuring its extent and impact.

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Figures

Fig. 1
Fig. 1
Maternal morbidity matrix, Dimension 1: SYMPTOM, SIGN, INVESTIGATIONS & MANAGEMENT (Direct Maternal Morbidity)
Fig. 2
Fig. 2
Maternal morbidity matrix, Dimension 1: SYMPTOM, SIGN, INVESTIGATIONS & MANAGEMENT (Indirect Maternal Morbidity)
Fig. 3
Fig. 3
Maternal morbidity matrix, Dimension 2: Functional Impact - International Classification for Functioning and Disability (ICF) codes
Fig. 4
Fig. 4
Maternal morbidity matrix, Dimension 3: Maternal History
See this image and copyright information in PMC

References

    1. Ronsmans C, Graham WJ. Maternal survival 1 - Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189–200. doi: 10.1016/S0140-6736(06)69380-X. - DOI - PubMed
    1. Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tuncalp O, et al. Measuring maternal health: focus on maternal morbidity. Bull World Health Organ. 2013;91(10):794–6. doi: 10.2471/BLT.13.117564. - DOI - PMC - PubMed
    1. Vanderkruik RC, Tuncalp O, Chou D, Say L. Framing maternal morbidity: WHO scoping exercise. BMC Pregnancy Childbirth. 2013;13(1):213. doi: 10.1186/1471-2393-13-213. - DOI - PMC - PubMed
    1. World Health Organization. Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division 2015.
    1. World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: WHO; 2011.

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