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Case Reports
. 2022 May 23;22(1):431.
doi: 10.1186/s12884-022-04731-x.

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions

Obiageli Okafor  1 , Nathalie Roos  2 , Abdulfetah Abdulkadir Abdosh  3 , Olubukola Adesina  4 , Zaynab Alaoui  5 , William Arriaga Romero  6 , Bouchra Assarag  7 , Olufemi Aworinde  8 , Luc de Bernis  9 , Rigoberto Castro  10 , Hassan Chrifi  7 , Louise Tina Day  11 , Rahel Demissew  12 , María Guadalupe Flores Aceituno  13 , Luis Gadama  14 , Biruck Gashawbeza  3 , Sourou Goufodji Keke  15 , Philip Govule  16 , George Gwako  17 , Kapila Jayaratne  18 , Evelyne Béwendin Komboigo  19 , Bredy Lara  20 , Mugove Gerald Madziyire  21 , Matthews Mathai  22 , Rachid Moulki  7 , Iatimad Moutaouadia  23 , Stephen Munjanja  24 , Carlos Alberto Ochoa Fletes  25 , Edgar Ivan Ortiz  26 , Henri Gautier Ouedraogo  27 , Zahida Qureshi  17 , Zenaida Dy Recidoro  28 , Hemantha Senanayake  29 , Priya Soma-Pillay  30 , Khaing Nwe Tin  31 , Pascal Sedami  32 , Dawit Worku  12 , Mercedes Bonet  33 ; WHO Global Maternal Sepsis Study- Maternal Death and Near-miss Review Working Group
Collaborators, Affiliations
Case Reports

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions

Obiageli Okafor et al. BMC Pregnancy Childbirth. .

Abstract

Background: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement.

Method: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework.

Results: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections.

Conclusion: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

Keywords: Audit; Infections; Maternal death; Near-miss; Perinatal; Virtual.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study profile. Note. * No deaths reported. **Western European countries did not collect WHO near-miss criteria
Fig. 2
Fig. 2
Number of modifiable factors identified in the review of 12 maternal deaths and 19 near-miss. Note. Bold numbers are total. Other clinical factors include antimicrobial resistance and unexplained prolonged hospitalization. Non-clinical factors include incomplete multidisciplinary team, delayed mobilization of the managing team, restrictive abortion policies and legislation, stigma of preexisting condition as a potential care barrier, discharge against medical advice
See this image and copyright information in PMC

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