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1.
BMJ Case Rep ; 17(2)2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38378590

RESUMO

The infratemporal fossa is an uncommon site for lodgement of foreign bodies. Fast-moving projectiles and displaced teeth may get impacted and have been described in the literature. However, foreign body lodgement in the retromaxillary space after transorbital passage is rare. The trajectory of the foreign bodies in such cases is difficult to predict and may not be suspected in the absence of overt clinical features. The authors present a case of a wooden splinter lodged within the infratemporal fossa after the patient sustained a lid injury with an orbital floor fracture. Imaging was equivocal; hence, endoscopic surgical exploration was undertaken, revealing the foreign body. A high index of clinical suspicion and rapid intervention is needed since unsuspected foreign bodies may cause further visual, infective or neurovascular complications. Approaches should be tailored on a case-by-case basis.


Assuntos
Corpos Estranhos , Fossa Infratemporal , Near Miss , Humanos , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Ossos Faciais , Endoscopia
2.
BMC Pregnancy Childbirth ; 24(1): 144, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38368373

RESUMO

BACKGROUND: Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. METHODS: A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. RESULTS: Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. CONCLUSION: The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity.


Assuntos
Morte Materna , Near Miss , Complicações na Gravidez , Gravidez , Feminino , Humanos , Near Miss/métodos , Cesárea , Mortalidade Materna , Complicações na Gravidez/epidemiologia , África/epidemiologia
3.
Cien Saude Colet ; 29(1): e17462022, 2024 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38198331

RESUMO

We aimed to analyze factors associated with neonatal near-miss in Cuiabá, State of Mato Grosso, Brazil by performing a case-control study of live births in a capital city of central-western Brazil from January 2015 to December 2018 that included 931 cases and 1,862 controls. Data were obtained from the Live Births Information System and the Mortality Information System and variables were organized according to the hierarchical model. Association was analyzed by logistic regression with a 5% significance level. Data were expressed as crude and adjusted odds ratio (OR) and respective confidence intervals (95%CI). The following factors were associated with neonatal near miss: mothers with two (OR = 1.63; 95%CI: 1.01-2.63) or three or more previous pregnancies (OR=1.87; 95%CI: 1.09-3.21), without any live children (OR = 2.57; 95%CI: 1.56-4.24 ) or one live child at birth (OR = 1.53; 95%CI: 1.04-2.26), multiple pregnancy (OR = 4.57; 95%CI: 2.95-7.07), fewer than six prenatal consultations (OR = 2.20; 95%CI: 1.77-2.72), whose deliveries took place in public/university hospitals (OR = 2.25; 95%CI: 1.60-3.15) or philanthropic hospitals (OR = 1.62; 95%CI: 1.16-2.26), with non-cephalic presentation (OR = 2.71 95%CI: 1.87-3.94) and uninduced labor (OR = 1.47; 95%CI: 1.18-1.84).


Objetivou-se analisar fatores associados ao near miss neonatal em Cuiabá, Mato Grosso. Estudo caso-controle de nascidos vivos em capital do Centro-Oeste brasileiro, de janeiro de 2015 a dezembro de 2018, com 931 casos e 1.862 controles. Os dados foram coletados no Sistema de Informações sobre Nascidos Vivos e no Sistema de Informações sobre Mortalidade. As variáveis foram organizadas seguindo o modelo hierárquico. A associação foi analisada por meio de regressão logística, com nível de significância de 5%. Os dados foram expressos em odds ratio (OR) bruta e ajustada e respectivos intervalos de confiança (IC95%). Mantiveram-se associados ao near miss neonatal: mães com duas (OR = 1,63; IC95%: 1,01-2,63) ou três ou mais gestações anteriores (OR = 1,87; IC95%: 1,09-3,21), sem nenhum filho (OR = 2,57; IC95%: 1,56-4,24) ou com um filho vivo ao nascer (OR = 1,53; IC95%: 1,04-2,26), gravidez múltipla (OR = 4,57; IC95%: 2,95-7,07), menos de seis consultas de pré-natal (OR = 2,20; IC95%: 1,77-2,72), partos realizados em hospitais públicos/universitários (OR = 2,25; IC95%: 1,60-3,15) e filantrópicos (OR = 1,62; IC95%: 1,16-2,26), apresentação não cefálica (OR = 2,71; IC95%: 1,87-3,94) e trabalho de parto não induzido (OR = 1,47 IC95%: 1,18-1,84).


Assuntos
Near Miss , Recém-Nascido , Criança , Feminino , Gravidez , Humanos , Estudos de Casos e Controles , Brasil/epidemiologia , Hospitais Públicos , Hospitais Universitários
4.
J Glob Health ; 14: 04024, 2024 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-38236696

RESUMO

Background: The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods: We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results: We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions: The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.


Assuntos
Near Miss , Complicações na Gravidez , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Cesárea/efeitos adversos , Idade Materna , Estudos Prospectivos
5.
BMC Pregnancy Childbirth ; 24(1): 42, 2024 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-38184536

RESUMO

BACKGROUND: Despite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or 'near miss' is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS: We conducted a prospective cohort study among women admitted for delivery at MRRH's maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes. RESULTS: We enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32-6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01-2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19-2.77). CONCLUSION: Maternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.


Assuntos
Hipertensão Induzida pela Gravidez , Near Miss , Gravidez , Lactente , Recém-Nascido , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Prospectivos , Uganda/epidemiologia , Período Pós-Parto , Natimorto/epidemiologia
6.
Int J Pharm Pract ; 32(1): 83-90, 2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38289996

RESUMO

OBJECTIVES: This study aimed to evaluate the effectiveness of workflow redesign (eaST system) on pharmacy waiting time and near-missed events. We also investigated other factors that may potentially affect these study outcomes. METHODS: A quasi-experimental (before-after) study design was adopted. Pre-intervention data were collected over 7 months (January-July 2017). Subsequently, the workflow redesign (eaST system) was implemented and the effect of the intervention (August 2017-February 2018) was evaluated. Univariate analysis was used to compare the differences between pre-intervention and post-intervention of pharmacy waiting time and near-missed events. Significant factors affecting study outcomes were analysed using linear regression analysis. KEY FINDINGS: A total of 210,530 prescriptions were analysed. The eaST system significantly increases the percentage of prescriptions dispensed within 30 min per day (median = 68 (interquartile range (IQR) = 41) vs. median = 93 (IQR = 33), P < 0.001) and reduced the mean percentage of near-missed events (mean = 50.71 (standard deviation (SD) = 23.95) vs. mean = 27.87 (SD = 12.23), P < 0.001). However, the eaST system's effects on related outcomes were conditional on a three-way interaction effect. The eaST system's effects on pharmacy waiting time were influenced by the number of prescriptions received and the number of PhIS server disruptions. Conversely, the eaST system's effects on near-missed events were influenced by the number of pharmacy personnel and number of controlled medications. CONCLUSIONS: Overall, the eaST system improved the pharmacy waiting time and reduced near-missed events.


Assuntos
Near Miss , Farmácia , Humanos , Fluxo de Trabalho , Malásia , Estudos Controlados Antes e Depois , Listas de Espera
7.
J Bone Joint Surg Am ; 106(1): 74-77, 2024 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-37669479

RESUMO

ABSTRACT: We present the case of a near-miss in clinical research to illustrate a situation in which errors in data collection would have led to different results in the data analysis, with the potential for drawing incorrect conclusions. Conclusions based on data errors may adversely influence future medical decision-making in patient care. In the interest of presenting this as an educational, nonpunitive, quality-improvement report, the study and the involved researchers remain anonymous, and the specific details and exact number of patients are not reported.


Assuntos
Near Miss , Humanos , Coleta de Dados , Avaliação de Resultados em Cuidados de Saúde
8.
J Perianesth Nurs ; 39(1): 10-15, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37855761

RESUMO

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.


Assuntos
Near Miss , Gestão de Riscos , Humanos , Segurança do Paciente , Salas Cirúrgicas , Acidentes , Erros Médicos/prevenção & controle
9.
Int J Gynaecol Obstet ; 164(1): 227-235, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37489017

RESUMO

OBJECTIVE: To assess the impact of maternal near-miss on late maternal death and the prevalence of hypertension or chronic kidney disease (CKD) and mental health problems at 12 months of follow up. METHODS: This prospective cohort study was conducted in a tertiary hospital in the southeastern region of India from May 2018 to August 2019, enrolling those with maternal near-miss and with follow up for 12 months. The primary outcomes were incidence of late maternal deaths and prevalence of hypertension and CKD during follow up. RESULTS: Incidence of maternal near miss was 6.7 per 1000 live births. Among those who had a near miss, late maternal deaths occurred in 7.2% (95% confidence interval [CI] 3.1%-11.3%); prevalence of CKD was 23.0% (95% CI 16.2%-29.8%), and of hypertension was 56.2% (95% CI 50.5%-66.5%) and only two women had depression on follow up. After adjusting for age, parity, socioeconomic status, gestational age at delivery, hemoglobin levels, and perinatal loss, only serum creatinine was independently associated with late maternal death and CKD on follow up. CONCLUSIONS: Women who survive a life-threatening complication during pregnancy and childbirth are at increased risk of mortality and one or more long-term sequelae contributing to the non-communicable disease burden. A policy shift to increase postpartum follow-up duration, following a high-risk targeted approach after a near-miss event, is needed.


Assuntos
Hipertensão , Morte Materna , Near Miss , Complicações na Gravidez , Insuficiência Renal Crônica , Gravidez , Feminino , Humanos , Complicações na Gravidez/epidemiologia , Morte Materna/etiologia , Estudos Prospectivos , Saúde Materna , Mortalidade Materna , Hipertensão/complicações , Insuficiência Renal Crônica/complicações
10.
Clin Nurs Res ; 33(2-3): 138-145, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38147002

RESUMO

The purpose of this study was to determine magnitude and associated factors of maternal near miss among women seeking obstetric and gynecologic care. A hospital based cross-sectional study design was implemented in selected public hospitals of Tigrai. Systematic random sampling method was used to select study participants. Data were entered to epi data manager version 4.1 and exported to Statistical Package for social science version 20 for analysis. Bivariate and multivariate logistic regression was used to identify factors associated with maternal near miss. The magnitude of maternal near miss was found to be 7.3%. Regression analysis showed that, mothers who reside in rural area, had distance of greater than 10 km, referred from low level health institution, and mothers had no antenatal care follow up were significantly associated with maternal near miss. Therefore, promoting antenatal care and increasing awareness in rural areas related with maternal health care services is recommended.


Assuntos
Near Miss , Complicações na Gravidez , Gravidez , Feminino , Humanos , Estudos Transversais , Etiópia , Hospitais Públicos
11.
Int J Epidemiol ; 53(1)2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38110741

RESUMO

BACKGROUND: The lifetime risk of maternal death quantifies the probability that a 15-year-old girl will die of a maternal cause in her reproductive lifetime. Its intuitive appeal means it is a widely used summary measure for advocacy and international comparisons of maternal health. However, relative to mortality, women are at an even higher risk of experiencing life-threatening maternal morbidity called 'maternal near miss' (MNM) events-complications so severe that women almost die. As maternal mortality continues to decline, health indicators that include information on both fatal and non-fatal maternal outcomes are required. METHODS: We propose a novel measure-the lifetime risk of MNM-to estimate the cumulative risk that a 15-year-old girl will experience a MNM in her reproductive lifetime, accounting for mortality between the ages 15 and 49 years. We apply the method to the case of Namibia (2019) using estimates of fertility and survival from the United Nations World Population Prospects along with nationally representative data on the MNM ratio. RESULTS: We estimate a lifetime risk of MNM in Namibia in 2019 of between 1 in 40 and 1 in 35 when age-disaggregated MNM data are used, and 1 in 38 when a summary estimate for ages 15-49 years is used. This compares to a lifetime risk of maternal death of 1 in 142 and yields a lifetime risk of severe maternal outcome (MNM or death) of 1 in 30. CONCLUSIONS: The lifetime risk of MNM is an urgently needed indicator of maternal morbidity because existing measures (the MNM ratio or rate) do not capture the cumulative risk over the reproductive life course, accounting for fertility and mortality levels.


Assuntos
Morte Materna , Near Miss , Complicações na Gravidez , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Complicações na Gravidez/epidemiologia , Near Miss/métodos , Saúde Materna , Mortalidade Materna , Morbidade
12.
BMC Health Serv Res ; 23(1): 1403, 2023 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-38093259

RESUMO

INTRODUCTION: Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia. METHODS: Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis. RESULTS: The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant. CONCLUSION: Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.


Assuntos
Método Canguru , Near Miss , Recém-Nascido , Feminino , Criança , Humanos , Adulto , Método Canguru/psicologia , Etiópia , Pesquisa Qualitativa , Pessoal de Saúde , Hospitais Públicos
13.
BMJ Open ; 13(11): e074215, 2023 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-37963695

RESUMO

INTRODUCTION: Maternal near-miss is a condition when a woman nearly died but survived from complications that happened during pregnancy, childbirth or within 42 days after delivery. Maternal near-miss is more prevalent among women in developing nations. Previous studies have identified the impact of different predictor variables on maternal near-miss but shared prognostic predictors are not adequately explored in Ethiopia. It is therefore necessary to build a clinical prediction model for maternal near-misses in Ethiopia. Hence, the aim of this study is to develop and validate a prognostic prediction model, and generate a risk score for maternal near-miss among pregnant women in Bahir Dar City Administration. METHODS AND ANALYSIS: A prospective follow-up study design will be employed among 2110 selected pregnant women in the Bahir Dar City administration from 1 May 2023 to 1 April 2024. At the initial antenatal visit, pregnant women will be systematically selected. Then, they will be followed until 42 days following birth. Data will be collected using structured questionnaires and data extraction sheet. The model will be created using Cox proportional hazard regression analysis. The performance of the model will be assessed based on its capacity for discrimination using c-index and calibration using calibration plot, intercept and slope. The model's internal validity will be evaluated through the bootstrapping method. Ultimately, the model will be illustrated through a nomogram and decision tree, which will be made available to prospective users. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Institutional Review Board of the College of Medicine and Health Sciences, Bahir Dar University (protocol number 704/2023). Findings will be published in peer-reviewed journals and local and international seminars, conferences, symposiums and workshops. Manuscripts will be prepared and published in scientifically reputable journals. In addition, policy briefs will be prepared.


Assuntos
Near Miss , Gestantes , Gravidez , Feminino , Humanos , Seguimentos , Estudos Prospectivos , Etiópia/epidemiologia , Modelos Estatísticos , Prognóstico
14.
BMC Pediatr ; 23(1): 573, 2023 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-37978460

RESUMO

BACKGROUND: Neonatal near-miss (NNM) can be considered as an end of a spectrum that includes stillbirths and neonatal deaths. Clinical audits of NNM might reduce perinatal adverse outcomes. The aim of this review is to evaluate the effectiveness of NNM audits for reducing perinatal mortality and morbidity and explore related contextual factors. METHODS: PubMed, Embase, Scopus, CINAHL, LILACS and SciELO were searched in February/2023. Randomized and observational studies of NNM clinical audits were included without restrictions on setting, publication date or language. PRIMARY OUTCOMES: perinatal mortality, morbidity and NNM. SECONDARY OUTCOMES: factors contributing to NNM and measures of quality of care. Study characteristics, methodological quality and outcome were extracted and assessed by two independent reviewers. Narrative synthesis was performed. RESULTS: Of 3081 titles and abstracts screened, 36 articles had full-text review. Two studies identified, rated, and classified contributing care factors and generated recommendations to improve the quality of care. No study reported the primary outcomes for the review (change in perinatal mortality, morbidity and NNM rates resulting from an audit process), thus precluding meta-analysis. Three studies were multidisciplinary NNM audits and were assessed for additional contextual factors. CONCLUSION: There was little data available to determine the effectiveness of clinical audits of NNM. While trials randomised at patient level to test our research question would be difficult or unethical for both NNM and perinatal death audits, other strategies such as large, well-designed before-and-after studies within services or comparisons between services could contribute evidence. This review supports a Call to Action for NNM audits. Adoption of formal audit methodology, standardised NNM definitions, evaluation of parent's engagement and measurement of the effectiveness of quality improvement cycles for improving outcomes are needed.


Assuntos
Near Miss , Morte Perinatal , Feminino , Humanos , Recém-Nascido , Gravidez , Auditoria Clínica , Morte Perinatal/prevenção & controle , Mortalidade Perinatal , Natimorto
17.
Rev Assoc Med Bras (1992) ; 69(10): e20230048, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37792865

RESUMO

OBJECTIVE: The aim of this study was to evaluate and compare Maternal Near Miss prevalence and outcomes before and during the coronavirus disease 2019 pandemic. METHODS: This retrospective study was carried out in a university maternity hospital of high complexity. The population was divided into two groups: G1, 1 year before the coronavirus disease 2019 pandemic period (August 2018-July 2019) and G2, 1 year during the pandemic period (August 2020-July 2021). All pregnant/postpartum women hospitalized up to 42 days after the end of pregnancy/childbirth were included, and pregnant women who were admitted with coronavirus disease 2019/flu symptoms were excluded. The association of variables with "Maternal Near Miss" was estimated using logistic regression. RESULTS: A total of 568 women from G1 and 349 women from G2 fulfilled the Maternal Near Miss criteria. The prevalence of Maternal Near Miss in pre-pandemic was 144.1/1,000 live births and during the pandemic was 78.5/1,000 live births. In the analysis adjusted for G1, the factors of days of hospitalization (PR: 1.02, CI: 1.0-1.0, p<0.05), pre-eclampsia (PR: 0.41, CI: 1.4-2.2, p<0.05), and sepsis/severe systemic infection (PR: 1.79, CI: 0.3-0.4, p<0.05) were crucial for women with the Maternal Near Miss condition to have a greater chance of being admitted to the intensive care unit. In G2, low education (PR: 0.45, CI: 0.2-0.9, p<0.05), eclampsia (PR: 5.28, CI: 3.6-7.6, p<0.05), and use of blood products (PR: 6.48, CI: 4.7-8.8, p<0.05) increased the risk of admission to the intensive care unit. CONCLUSION: During the pandemic, there was a lower prevalence of Maternal Near Miss in high-risk pregnancies, fewer hospitalizations, and more deaths compared to the non-pandemic period.


Assuntos
COVID-19 , Near Miss , Hemorragia Pós-Parto , Complicações na Gravidez , Feminino , Gravidez , Humanos , Complicações na Gravidez/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Estudos Retrospectivos , Pandemias , COVID-19/epidemiologia , Mortalidade Materna
18.
J Matern Fetal Neonatal Med ; 36(2): 2260056, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37748920

RESUMO

Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.


Assuntos
COVID-19 , Near Miss , Gravidez , Humanos , Feminino , Adulto , Estudos de Coortes , COVID-19/complicações , COVID-19/epidemiologia , Estudos Retrospectivos , Brasil/epidemiologia , Cesárea , Estudos Prospectivos , Encaminhamento e Consulta
19.
Indian J Med Res ; 158(1): 66-74, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-37602588

RESUMO

Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.


Assuntos
Aborto Induzido , Near Miss , Gravidez , Humanos , Feminino , Centros de Atenção Terciária , Incidência , Índia/epidemiologia
20.
Curr Hypertens Rev ; 19(3): 173-179, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37581519

RESUMO

INTRODUCTION: The extent of maternal morbidity is a good gauge of a nation's maternal health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide useful information in this context. Such women who survive these life-threatening conditions arising from complications during pregnancy, childbirth and post partum (42 days) share many commonalities with those who die because of such complications. AIM: To assess the organ dysfunction and the underlying causes, associated/contributory factors associated with "maternal near-miss" cases in pregnant, in labor, post-partum women (upto42 days) in the health care facilities of Doiwala block, district Dehradun. MATERIALS AND METHODS: The present study was conducted over a period of 6 months under the Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh. The cross-sectional study included the medical record files of all pregnant women attending the Department of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district Dehradun. This study was conducted as per the WHO criteria for "near-miss" by using convenience sampling for the selection of healthcare facilities. The medical record files of all women who were pregnant, in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 - 31.05.2022. RESULTS: It was found that Out of the women with maternal near-miss (n=91), the majority of women had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction (n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%). Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders (n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had pregnancy-related infection. It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63, 69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%). CONCLUSION: Pregnancy should be a positive experience for every woman of childbearing age. A better understanding of pregnancy-related conditions enables early detection of complications and prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes with long-term health implications or death. There are already effective measures in place to reduce maternal and newborn mortality and morbidity.


Assuntos
Near Miss , Complicações do Trabalho de Parto , Complicações na Gravidez , Recém-Nascido , Feminino , Gravidez , Humanos , Estudos Retrospectivos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Estudos Transversais , Cesárea , Insuficiência de Múltiplos Órgãos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Atenção à Saúde
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