A systematic review of maternal near miss and mortality due to postpartum hemorrhage

BACKGROUND: Postpartum hemorrhage (PPH) is the principal direct cause of maternal mortality worldwide. Analysis of maternal near miss could increase understanding of survival among women with life-threatening PPH. OBJECTIVES: To determine the near-miss ratio and maternal mortality index for PPH globally. SEARCH STRATEGY: A prevalence systematic review was conducted of English-language articles published from 1995 to 2014. Suitable articles were identified from the Scopus, PubMed, Embase, and Grey Literature databases. The main search terms used were "maternal near-miss" and "severe acute maternal morbidity." SELECTION CRITERIA: Near-miss studies and audits describing the severe maternal outcome rate for PPH were included. DATA COLLECTION AND ANALYSIS: Data were extracted from eligible publications. Quantitative analysis and narrative synthesis were used. MAIN RESULTS: For 26 included studies, the median near-miss ratio for PPH was 3 per 1000 live births. The mortality index for PPH was 6.6% (range 0.0%-40.7%). The mortality index was highest in low-income countries and lower middle-income countries. Overall, PPH was the most frequent contributor to obstetric hemorrhage, with atonic uterus identified as the main cause. CONCLUSIONS: Women in low-income countries and lower middle-income countries have an increased likelihood of severe PPH and of dying from PPH-related consequences.