DEFINITION AND INDICATORS OF MATERNAL NEAR MISS/SEVERE MATERNAL MORBIDITY: A SYSTEMATIC REVIEW

Objectives There continues to be international interest in monitoring maternal near miss (MNM)/severe maternal morbidity (SMM) as an adjunct to research on maternal mortality. In contrast to the universal agreement in the importance of this entity, there is widespread variability in the term itself and which indicators should be used to monitor these events. This systematic review aimed to summarize both the terms and indicators that are being used regarding this concept. Methods In June 2018, we systematically searched Medline, EMBASE, and CINAHL for research on MNM/SMM. We included papers that used at least 3 indicators to evaluate MNM/SMM in pregnancy, delivery, and/or the puerperium. Results Our initial search yielded 18,832 articles, of which 178 were included in the review. Of these papers, 38.76% (69/178) used the term SMM, 34.27% (61/178) used MNM, and the remaining 26.97% (48/178) used a different term. For monitoring, 37.64% (67/178)used indicators recommended by the World Health Organization (WHO), 7.30% (13/178) used indicators recommended by the Centers for Disease Control (CDC), 26.97% (48/178) used indicators by previous authors, 8.99% (16/178) described the process for developing a unique set of indicators for their study, and 19.10% (34/178) did not provide information on why included indicators were chosen. Importantly, 98.31% (175/178) included hemorrhage/related indicators, while only 4.49% (8/178) included psychosis/related indicators. Conclusions While there is clear interest in MNM/SMM, our review highlights current inconsistencies and shows there is an urgent need to standardize these entities to promote a concerted global effort in addressing MNM/SMM. There continues to be international interest in monitoring maternal near miss (MNM)/severe maternal morbidity (SMM) as an adjunct to research on maternal mortality. In contrast to the universal agreement in the importance of this entity, there is widespread variability in the term itself and which indicators should be used to monitor these events. This systematic review aimed to summarize both the terms and indicators that are being used regarding this concept. In June 2018, we systematically searched Medline, EMBASE, and CINAHL for research on MNM/SMM. We included papers that used at least 3 indicators to evaluate MNM/SMM in pregnancy, delivery, and/or the puerperium. Our initial search yielded 18,832 articles, of which 178 were included in the review. Of these papers, 38.76% (69/178) used the term SMM, 34.27% (61/178) used MNM, and the remaining 26.97% (48/178) used a different term. For monitoring, 37.64% (67/178)used indicators recommended by the World Health Organization (WHO), 7.30% (13/178) used indicators recommended by the Centers for Disease Control (CDC), 26.97% (48/178) used indicators by previous authors, 8.99% (16/178) described the process for developing a unique set of indicators for their study, and 19.10% (34/178) did not provide information on why included indicators were chosen. Importantly, 98.31% (175/178) included hemorrhage/related indicators, while only 4.49% (8/178) included psychosis/related indicators. While there is clear interest in MNM/SMM, our review highlights current inconsistencies and shows there is an urgent need to standardize these entities to promote a concerted global effort in addressing MNM/SMM.