Table 1

Maternal near-miss terminology and indicators[8,9]
Maternal Near Miss (MNM) A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.
Maternal Death (MD) Death of a woman while pregnant or within 42 days of termination of pregnancy or its management, but not from accidental or incidental causes.
Live Birth (LB) The birth of an offspring, which breathes or shows evidence of life.
Severe maternal outcome (SMO) A life-threatening condition (i.e. organ dysfunction), including all maternal deaths and maternal near-miss cases.
Women with life-threatening conditions (WLTC) All women who either qualified as having maternal near miss or who died. It is the sum of maternal near miss and maternal deaths.
Maternal Near Miss Ratio (MNMR) The number of maternal near miss cases per 1,000 live births.
Severe Maternal Outcome Ratio (SMOR) The number of women with life threatening conditions per 1,000 live births. This indication gives an estimation of the amount of care and resources that would be needed in an area or facility.
Maternal Near Miss Mortality Ratio: The ratio between maternal near-miss cases and maternal deaths. Higher ratios indicate better care.
Mortality Index The number of maternal deaths divided by the number of women with life threatening conditions, expressed as a percentage. The higher the index the more women with life-threatening conditions die (low quality of care), whereas the lower the index the fewer women with life-threatening conditions die (better quality of care).
Perinatal outcome indicators (e.g. perinatal mortality, neonatal mortality or stillbirth rates) in the context of maternal miss could be useful to complement the quality of care evaluation.
Hospital Access Indicators:
The following indicators are used to explore the access to the facility in terms of functioning referral systems. · SMO12: Cases presenting the organ dysfunction or maternal death within 12 hours of hospital stay
· Proportion of SMO12 cases among all SMO cases
· Proportion of SMO12 cases coming from other facilities
· SMO12 mortality index: The number of SMO12 cases divided by the number of all SMO cases expressed as a percentage.
Intra-hospital Care:
The following indicators are used to explore access to quality care in the facility: · Intra-hospital SMO: Cases presenting the organ dysfunction or maternal death after 12 hours of hospital stay.
· Intra-hospital SMO rate (per 1000 live births): The number of intra-hospital SMO cases per 1000 live births.
· Intra-hospital mortality index: The number of intra-hospital SMO cases divided by the number of all SMO cases expressed as a percentage.
· ICU admission rate: The number of women admitted to ICU among total number of womengiving birth.
· ICU admission rate among women with SMO: The number of women with SMO divided by the ICU admissions among total number of women giving birth.
Process Indicators:
The following indicators are used to assess the coverage of selected evidence-based interventions used for prevention and treatment of the main causes of maternal deaths. · Prevention of postpartum hemorrhage: The number of women who received a single dose of oxytocin divided by the number of all women giving birth (vaginal delivery + cesarean section)
· Treatment of severe postpartum hemorrhage: The number of women with severe PPH who received therapeutic oxytocin divided by the number of all women with postpartum hemorrhage.
· Eclampsia: The number of women with eclampsia who received magnesium sulfate divided by the number of all women with eclampsia.
· Prevention of severe systemic infections/sepsis: The number of women having a cesarean section and receiving prophylactic antibiotics divided by the number of all women having cesarean sections.
· Treatment of severe infections and sepsis: The number of women with severe systemic infections or sepsis who received IV antibiotics divided by the number of all women with severe systemic infections or sepsis.
· Fetal lung maturation: The number of women having a live birth after 3 hours of hospital stay and receiving corticosteroids for fetal lung maturation divided by all women having a live birth after 3 hours of hospital stay.

Jabir et al.

Jabir et al. BMC Pregnancy and Childbirth 2013 13:11   doi:10.1186/1471-2393-13-11

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