Infection-related maternal deaths and near-miss in 11 GLOSS countries

A recent paper published in BMC Pregnancy and Childbirth used data from 15 facilities across 11 GLOSS countries to conduct a virtual confidential inquiry to understand factors linked to infection-related maternal deaths and near-miss. The paper also provides with suggested actions, including the implementation of virtual platforms to improve routine adoption of confidential reviews.

To read the full article, please click here.

Remember to visit our resources page for other resources to use in your facilities.

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Abstract

Background: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement.

Methods: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework.

Results: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections.

Conclusion: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

Infection prevention and control in maternal and neonatal care training toolkit

WHO recently launched a new training course on infection prevention and control for maternal and neonatal care. The course is aimed at staff working in maternal and neonatal wards, specifically, antenatal care outpatient services, maternal and neonatal inpatient services, and neonatal intensive care services.

The course is divided into 6 sessions. The first session covers the essential knowledge of standard precautions required for good infection prevention and control. The other five sessions develop this knowledge and apply it clinically to common situations in antenatal care, labour, childbirth and neonatal care. Currently the first three sessions are available.

  • Module 1: Introduction to Infection prevention and control
  • Module 2: Care of the pregnant woman in antenatal clinic
  • Module 3: Admission of the pregnant woman, labour and uncomplicated childbirth
  • Module 4: When interventions are required in labour (in production)
  • Module 5: Caesarean section (in production)
  • Module 6: Special neonatal circumstances (in production)

Registration is open through openWHO.