National maternal near-miss study in Oman

Omani women in traditional dress

Background
Maternal death review is one of the recommended approaches to improve quality of care in countries with high numbers of maternal deaths. In countries with few maternal deaths, a complementary approach is to review the care provided to women who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy ꟷ known as “Maternal Near Miss”.

Oman has a comprehensive maternal deaths review system with a relatively low number of maternal deaths. However, most of these deaths are preventable. The number of severe maternal morbidities are unknown and there is no standard review system for these cases. The maternal near-miss review system has been introduced through this study, to further improve the quality of care and reduce the number of maternal deaths. Specifically, the objectives of this study are to determine the incidence, underlying causes of, contributory conditions and factors associated with maternal near-miss and to make recommendations for improving the quality of maternal care in Oman.  

Methods
A total of 23 healthcare facilities of various levels and across the country were selected to participate in the study. More than 90% of the total child births in Oman take place in these facilities. A trained focal doctor and all staff in the obstetrics and gynaecology department in each participating healthcare facility were oriented to report all cases of potentially life-threatening conditions. From these, maternal near-miss cases were then identified using agreed criteria. The criteria were developed based on the World Health Organization application of International Classification of Diseases version 10 for Maternal Mortality (ICD-10 MM) to deaths during pregnancy, childbirth and puerperium. Potentially life-threatening conditions are defined by World Health Organization as any clinical conditions, that can threaten a woman’s life during pregnancy and labour and after termination of pregnancy.

To facilitate data collection, a maternal near-miss App was developed, which consisted of an electronic maternal identification form with the maternal near-miss identification criteria. The App was used by all 23 healthcare facilities.

From October 2016 to September 2017, all cases fulfilling the maternal near-miss criteria were reviewed at healthcare facility level and by the Regional Maternal Mortality Committee. 50% of cases were reviewed by the National Maternal Mortality Committee and by an international expert panel in the UK. All reviewers were oriented and trained on the review process.