Similarities and differences between WHO criteria and two other approaches for maternal near miss diagnosis

Filipe Emanuel Fonseca Menezes; Larissa Paes Leme Galvão; Caio Menezes Machado de Mendonça; Kaique Andre do Nascimento Góis; Ruy Farias Ribeiro Jr; Victor Santana Santos; Ricardo Queiroz Gurgel

doi:10.1111/tmi.12568

Similarities and differences between WHO criteria and two other approaches for maternal near miss diagnosis

Trop Med Int Health. 2015 Nov;20(11):1501-1506. doi: 10.1111/tmi.12568. Epub 2015 Aug 5.

Authors

Filipe Emanuel Fonseca Menezes¹, Larissa Paes Leme Galvão², Caio Menezes Machado de Mendonça¹, Kaique Andre do Nascimento Góis¹, Ruy Farias Ribeiro Jr¹, Victor Santana Santos¹, Ricardo Queiroz Gurgel^{1

2}

Affiliations

¹ Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
² Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil.

PMID: 26192138
DOI: 10.1111/tmi.12568

Abstract

Objectives: To evaluate the similarities, differences and diagnostic aspects between World Health Organization (WHO) criteria and two other maternal near miss (MNM) diagnostic tools.

Methods: A cross-sectional study was conducted from June 2011 to May 2012 in two reference maternity hospitals in Aracaju, Brazil. Prospective case identification and data collection were performed and patients were classified as an MNM case according to WHO, Waterstone and literature-based criteria. The diagnostic properties and concordance of literature-based and Waterstone criteria were calculated using WHO criteria as standard.

Results: Of a total of 20 435 patients, 19 239 women did not have potentially life-threatening conditions, there were 17 maternal deaths, and 77 MNM cases based on the WHO criteria. Waterstone and literature-based criteria identified 404 and 959 MNM cases, respectively, most of them related to hypertensive disorders and haemorrhage. The sensitivity, specificity and accuracy in diagnosing MNM cases using Waterstone and literature-based criteria were above 90%, but Waterstone sensitivity was 48.1%. The similarities between the Waterstone and literature-based criteria were very weak compared to WHO criteria, with a positive percentage concordance below 9%.

Conclusions: Although using WHO guidelines to detect MNM cases can be difficult when implemented in low-resource settings, the results from this study reinforce the importance of this tool in detecting the truly severe cases. Waterstone and literature-based criteria are not suitable for identifying indubitable MNM. However, they remain useful as a preliminary step to select potentially severe cases, mainly those related to hypertension and haemorrhage.

Keywords: Morbilidad Materna Extrema; cas maternels graves; casos severos; décès maternels évités de justesse; maternal health; maternal near miss; maternal severe cases; morbidité maternelle grave; salud maternal; santé maternelle; severe maternal morbidity.