Maternal near miss: reaching the last mile

Abstract

Maternal mortality misses the morbidity associated with pregnancy and delivery. Maternal Near Miss is an alternate measure that reflects maternal morbidity and in areas with low maternal mortality improves comparability. Maternal Near Miss is a proxy indicator of the quality of healthcare services and helps in understanding health system failures with relation to obstetric care and addressing them. But regional variations in availability of resources have led to a dozen different adapted versions of WHO Maternal Near Miss criteria. This creates confusion and reduces comparability, nationally and internationally. A review of articles defining maternal near miss was conducted using a PubMed search to compare and assess the various definitions of MNM. The present article summarises the available criteria and discusses the advantages and drawbacks of WHO MNM criteria as compared to others. The objective is to impress the need to have comprehensive criteria that can be applied in different settings and ensure comparability.Impact statementWhat is already known on this subject? Many different definitions and criteria to diagnose Maternal Near Miss are available. They are diverse, thereby reducing comparability both nationally and internationally.What do the results of this study add? This article summarises the differences in the available definitions and classifying criteria. It also highlights the difficulty in usage of the criteria in different settings.What are the implications of these findings for clinical practice and/or further research? This calls for researchers working in areas of maternal health to further simplify the definitions and criteria used for identification of Maternal Near Miss to improve comparability and uniformity.

Keywords: Filippi criteria; Global Network Near-Miss Maternal Mortality System; Maternal near miss; WHO MNM criteria; five-factor system; sub-Saharan adaptation.