The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity
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"last_name"=>"Quintana", "scopus_author_id"=>"7004365153"}, {"first_name"=>"Ivelyne", "last_name"=>"Radaci", "scopus_author_id"=>"55348166300"}, {"first_name"=>"Edilberto A.Rocha", "last_name"=>"Filho", "scopus_author_id"=>"55347699200"}, {"first_name"=>"Simone M.", "last_name"=>"Rodrigues", "scopus_author_id"=>"55348359500"}, {"first_name"=>"Roger D.", "last_name"=>"Rohloff", "scopus_author_id"=>"55347971800"}, {"first_name"=>"Marilza V.", "last_name"=>"Rudge", "scopus_author_id"=>"56207436500"}, {"first_name"=>"Gloria C.", "last_name"=>"Saint'ynes", "scopus_author_id"=>"55348112900"}, {"first_name"=>"Danielly S.", "last_name"=>"Santana", "scopus_author_id"=>"37110131400"}, {"first_name"=>"Patricia N.", "last_name"=>"Santos", "scopus_author_id"=>"55210041900"}, {"first_name"=>"Lale", "last_name"=>"Say", "scopus_author_id"=>"55348073800"}, {"first_name"=>"Luiza E.", "last_name"=>"Schmaltz", "scopus_author_id"=>"35771573400"}, {"first_name"=>"Maria H.", "last_name"=>"Sousa", "scopus_author_id"=>"9744867500"}, {"first_name"=>"Maria R.", "last_name"=>"Sousa", "scopus_author_id"=>"55347883600"}, {"first_name"=>"Joäo P.", "last_name"=>"Souza", "scopus_author_id"=>"55081791700"}, {"first_name"=>"Fernanda G.", "last_name"=>"Surita", "scopus_author_id"=>"6504123736"}, {"first_name"=>"Elvira A.", "last_name"=>"Zanette", "scopus_author_id"=>"55347677300"}, {"first_name"=>"Vilma", "last_name"=>"Zotareli", "scopus_author_id"=>"37118336200"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"doi"=>"10.1371/journal.pone.0044129", "sgr"=>"84865584954", "isbn"=>"1932-6203", "pmid"=>"22952897", "issn"=>"19326203", "scopus"=>"2-s2.0-84865584954", "pui"=>"365542883"}, "id"=>"d2045227-ca72-3a33-b2d8-e499e0cfcbf2", "abstract"=>"OBJECTIVES To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. METHODS In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. RESULTS Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993)). CONCLUSION The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.", "link"=>"http://www.mendeley.com/research/maternal-nearmiss-approach-maternal-severity-index-model-msi-tools-assessing-management-severe-mater", "reader_count"=>143, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>11, "Librarian"=>2, "Researcher"=>19, "Student > Doctoral Student"=>11, "Student > Ph. D. 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Student"=>19, "Student > Postgraduate"=>25, "Other"=>6, "Student > Master"=>22, "Student > Bachelor"=>9, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>4, "Professor"=>9}, "reader_count_by_subject_area"=>{"Unspecified"=>6, "Agricultural and Biological Sciences"=>3, "Arts and Humanities"=>1, "Business, Management and Accounting"=>3, "Economics, Econometrics and Finance"=>1, "Energy"=>1, "Environmental Science"=>1, "Nursing and Health Professions"=>12, "Mathematics"=>1, "Medicine and Dentistry"=>98, "Psychology"=>1, "Social Sciences"=>14, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>98}, "Social Sciences"=>{"Social Sciences"=>14}, "Psychology"=>{"Psychology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>6}, "Environmental Science"=>{"Environmental Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Energy"=>{"Energy"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>12}}, "reader_count_by_country"=>{"Brazil"=>6, "United Kingdom"=>2, "Kenya"=>1, "Switzerland"=>1, "Spain"=>1, "Indonesia"=>2}, "group_count"=>10}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/584534"], "description"=>"*<p>In this table maternal near-miss cases are the false positives.</p>", "links"=>[], "tags"=>["severity", "markers", "maternal", "deaths", "women", "pregnancy-related", "complications"], "article_id"=>255021, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t002", "stats"=>{"downloads"=>4, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Accuracy_of_the_WHO_set_of_severity_markers_in_the_prediction_of_maternal_deaths_among_all_women_and_women_with_pregnancy_related_complications_/255021", "title"=>"Accuracy of the WHO set of severity markers in the prediction of maternal deaths among all women and women with pregnancy-related complications <sup>*</sup>.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:23:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/584570"], "description"=>"*<p>N = 82,388 deliveries.</p>", "links"=>[], "tags"=>["severity", "markers", "maternal"], "article_id"=>255066, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t003", "stats"=>{"downloads"=>3, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Relationship_between_severity_markers_WHO_criteria_and_maternal_deaths_/255066", "title"=>"Relationship between severity markers (WHO criteria) and maternal deaths.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:24:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/584614"], "description"=>"*<p>A glossary with relevant operational definitions is available at reference 28. Stratification of the WHO life-threatening conditions is based on the SOFA score (reference 30). Group B reflects SOFA score categories 3 and 4 (i.e. markers of greater severity).</p>", "links"=>[], "tags"=>["severity", "markers", "maternal", "near-miss"], "article_id"=>255103, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t001", "stats"=>{"downloads"=>4, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_WHO_set_of_severity_markers_life_threatening_conditions_used_in_maternal_near_miss_assessments_/255103", "title"=>"The WHO set of severity markers (life-threatening conditions) used in maternal near-miss assessments.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:25:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/584417"], "description"=>"*<p>Listed in the <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044129#pone-0044129-t001\" target=\"_blank\">Table 1</a>.</p>#<p>Presence of any of the following conditions: pH <7.1, Use of continuous vasoactive drugs, Cardiac arrest, Cardio-pulmonary resuscitation (CPR).</p>£<p>Presence of any of the following conditions: Gasping, PaO2/FiO2<200 mmHg, Intubation and ventilation not related to anesthesia.</p>", "links"=>[], "tags"=>["maternal", "severity"], "article_id"=>254908, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t006", "stats"=>{"downloads"=>6, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_Maternal_Severity_Index_MSI_/254908", "title"=>"The Maternal Severity Index (MSI).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:21:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/584497"], "description"=>"*<p>The Hosmer-Lemeshow test indicates a poor fit if p value is less than 0.05.</p>£<p>The Nagelkerke R<sup>2</sup> values the proportion of variance in maternal mortality associated with the models’ predictors. Higher R<sup>2</sup> values, better model performance.</p>@<p>Area under the receiver operating characteristic curve with 95% confidence intervals calculated among women with life-threatening conditions of the subpopulation “B”.</p><p>N.A.: not applicable.</p>", "links"=>[], "tags"=>["models", "ii", "maternal", "severity"], "article_id"=>254986, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t005", "stats"=>{"downloads"=>2, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_performance_of_the_models_I_and_II_and_the_maternal_severity_score_/254986", "title"=>"The performance of the models I and II and the maternal severity score.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:23:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/584359"], "description"=>"<p>The relationship between the number of severity markers and mortality (the size of each bubble denotes the amount of cases).</p>", "links"=>[], "tags"=>["severity", "markers", "denotes"], "article_id"=>254844, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.g001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_relationship_between_the_number_of_severity_markers_and_mortality_the_size_of_each_bubble_denotes_the_amount_of_cases_/254844", "title"=>"The relationship between the number of severity markers and mortality (the size of each bubble denotes the amount of cases).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-08-29 01:20:44"}
  • {"files"=>["https://ndownloader.figshare.com/files/307832"], "description"=>"<div><h3>Objectives</h3><p>To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments.</p> <h3>Methods</h3><p>In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity.</p> <h3>Results</h3><p>Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56–114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909–0.993)).</p> <h3>Conclusion</h3><p>The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.</p> </div>", "links"=>[], "tags"=>["maternal", "near-miss", "severity", "tools", "assessing", "morbidity"], "article_id"=>120735, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129", "stats"=>{"downloads"=>9, "page_views"=>55, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/The_WHO_Maternal_Near_Miss_Approach_and_the_Maternal_Severity_Index_Model_MSI_Tools_for_Assessing_the_Management_of_Severe_Maternal_Morbidity/120735", "title"=>"The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 00:12:15"}
  • {"files"=>["https://ndownloader.figshare.com/files/584448"], "description"=>"*<p>The Pearson correlation coefficient between the maternal severity score and mortality is 0.96.</p>", "links"=>[], "tags"=>["severity", "markers"], "article_id"=>254943, "categories"=>["Medicine", "Cell Biology", "Biotechnology"], "users"=>["Joao Paulo Souza", "Jose Guilherme Cecatti", "Samira M. Haddad", "Mary Angela Parpinelli", "Maria Laura Costa", "Leila Katz", "Lale Say"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0044129.t004", "stats"=>{"downloads"=>4, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Relationship_between_the_number_of_severity_markers_maternal_severity_score_and_mortality_/254943", "title"=>"Relationship between the number of severity markers (maternal severity score) and mortality<sup>*</sup>.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-08-29 01:22:23"}

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Relative Metric

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