Abstract:
AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near
miss).
METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol,
an extensive search strategy of 10 electronic databases as well as other sources. Articles were
evaluated according to specified inclusion criteria. Data were extracted using data extraction
instrument which collects additional information on the quality of reporting including definitions
and identification of cases. Data were entered into a specially constructed database and tabulated
using SAS statistical management and analysis software.
RESULTS: A total of 30 studies are included in the systematic review. Designs are mainly crosssectional
and 24 were conducted in hospital settings, mostly teaching hospitals. Fourteen studies
report on a defined SAMM condition while the remainder use a response to an event such as
admission to intensive care unit as a proxy for SAMM. Criteria for identification of cases vary widely
across studies. Prevalences vary between 0.80% – 8.23% in studies that use disease-specific criteria
while the range is 0.38% – 1.09% in the group that use organ-system based criteria and included
unselected group of women. Rates are within the range of 0.01% and 2.99% in studies using
management-based criteria. It is not possible to pool data together to provide summary estimates
or comparisons between different settings due to variations in case-identification criteria.
Nevertheless, there seems to be an inverse trend in prevalence with development status of a
country.
CONCLUSION: There is a clear need to set uniform criteria to classify patients as SAMM. This
standardisation could be made for similar settings separately. An organ-system dysfunction/failure
approach is the most epidemiologically sound as it is least open to bias, and thus could permit
developing summary estimates.
