Basis for Establishing a System of Active Surveillance and Rapid Response for the Management of Severe Maternal Morbidity

Abstract

INTRODUCTION: Maternal mortality ratio (MMR) has been used as an indicator of maternal health regardless of the previous events. Severe maternal morbidity (SMM) refers to women with life-threatening pregnancy-associated morbidity, who ultimately survive. OBJECTIVES: To investigate the status of maternal mortality (MM) and SMM in Misiones, Jujuy and La Rioja. To establish the basis for a system of surveillance and case management. METHODS: A multicenter prevalence study was conducted, with an implementation component. Pregnant women assisted from October 1, 2013 to March 31, 2014 in the public sub-sector were screened for potentially fatal conditions (PFC) and SMM and MM notification. RESULTS: A total of 9921 births were analyzed. From 294 women participating in the study, there were 219 (74.5%) cases of PFC, 67 (22.8%) of SMM and 8 (2.7%) of MM. Clinical screening criteria identified 78.1% of cases of PFC, disease criteria identified SMM 94%, and 100% of MM showed some clinical criterion. The main causes of SMM were hypertensive disorders (35.8%), hemorrhagic disorders (29.9%) and abortion complications (13.4%). Global incidence of PFC was 2.21%, and for SMM and MM was 0.68% and 0.08%, respectively. The overall morbidity index was 8.4 (4.0-7.4), the overall mortality rate was 10.7%, and the overall use of beneficial interventions for the management of SMM was 54.8%. CONCLUSIONS: The study yielded information on MM and SMM in the three provinces and laid the groundwork for implementing a system of active surveillance and rapid response to handle SMM consistently with the National Operational Plan.