Document Type : Original Article
Authors
1 Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
Abstract
INTRODUCTION: Investigating severe maternal morbidity and near‑miss cases are applied
internationally as a new indicator to examine the quality of maternal care and as an effective strategy
to reduce maternal mortality. This study aimed to determine the root causes of severe maternal
morbidity in order to improve maternal health.
MATERIALS AND METHODS: The present research is a descriptive case series study. The data was
obtained from the hospital and health records of mothers admitted to hospitals affiliated to Isfahan
University of Medical Sciences due to severe morbidity in the first 6 months of 2018, which were
selected randomly. The data collection was completed by interviews with the mentioned mothers and
14 related health‑care staffs and that led to the development of the morbidity story. The compiled
story of each case was evaluated by the root analysis team’s opinion. Causes of morbidity were
determined according to a root cause analysis checklist composing of factors such as health‑care
services (human and structural factors), family‑social status, and disease status of maternal morbidity.
RESULTS: The findings indicated that human factors related to the health system led to severe
maternal morbidity more than any cause. Inadequate knowledge and skills of service providers,
disregard for guidelines and protocols, lack of teamworking, and lack of considering competency
were the most important human factors. Disease condition, family, and social status were the other
related factors, respectively.
CONCLUSION: Human factors are the most important cause of maternal morbidity based on the
results of this study. Therefore, modifying the health structure can be one of the most important
reducing factors for maternal mortality in order to improve the services for these individuals.
Keywords
Investigation of the causes of maternal mortality using root cause
analysis in Isfahan, Iran in 2013-2014. Iran J Nurs Midwifery Res
2015;20:315-21.
2. Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F,
Lawton B. A global view of severe maternal morbidity: Moving
beyond maternal mortality. Reprod Health 2018;15:98.
3. World Health Organisation. Evaluating the Quality of Care
for Severe Pregnancy Complications: The WHO Near-Miss
Approach for Maternal Health. Geneva, Switzerland: World
Health Organisation; 2011.
4. Naderi T, Foroodnia S, Omidi S, Samadani F, Nakhaee N.
Incidence and correlates of maternal near miss in southeast Iran.Int J Reprod Med 2015;2015: 1-5
5. Tallapureddy S, Velagaleti R, Palutla H, Satti CV. “Near-Miss”
obstetric events and maternal mortality in a tertiary care hospital.
Indian J Public Health 2017;61:305-8.
6. Norhayati MN, Nik Hazlina NH, Sulaiman Z, Azman MY.
Severe maternal morbidity and near misses in tertiary hospitals,
Kelantan, Malaysia: A cross-sectional study. BMC Public Health
2016;16:229.
7. Alemu FM, Fuchs MC, Martin Vitale T, Abdalla Mohamed Salih M.
Severe maternal morbidity (near-miss) and its correlates in the
world’s newest nation: South Sudan. Int J Womens Health
2019;11:177-90.
8. Charles R, Hood B, Derosier JM, Gosbee JW, Li Y, Caird MS,
et al. How to perform a root cause analysis for workup and
future prevention of medical errors: A review. Patient Saf Surg
2016;10:20.
9. Madzimbamuto FD, Ray SC, Mogobe KD, Ramogola-Masire D,
Phillips R, Haverkamp M, et al. A root-cause analysis of maternal
deaths in Botswana: Towards developing a culture of patient
safety and quality improvement. BMC Pregnancy Childbirth
2014;14:231.
10. Mahmood MA, Mufidah I, Scroggs S, Siddiqui AR, Raheel H,
Wibdarminto K, et al. Root-cause analysis of persistently high
maternal mortality in a rural district of Indonesia: Role of clinical
care quality and health services organizational factors. Biomed
Res Int 2018;2018:1-11
11. Okonofua F, Ntoimo LFC, Ogu R, Galadanci H, Gana M,
Adetoye D, et al. Assessing the knowledge and skills on
emergency obstetric care among health providers: Implications for
health systems strengthening in Nigeria. PLoS One 2019;14:1-17.
12. Wong JY, Chan MM, Lok KY, Ngai VF, Pang MT, Chan CK, et al.
Chinese women health ambassadors programme: A process
evaluation. J Clin Nurs 2017;26:2976-85.
13. Bahreini S, Beigi M, Rahimi M, Valiani M. Analysis of maternal
mortality in Isfahan, Iran: A case series study. Ann Trop Med
Public Health 2017;10:1591.
14. Riley W, Begun JW, Meredith L, Miller KK, Connolly K,
Price R, et al. Integrated approach to reduce perinatal adverse
events: standardized processes, interdisciplinary teamwork
training, and performance feedback. Health Serv Res
2016;51 Suppl 3:2431-52.
15. Portela MC, Lima SML, da Costa Reis LG, Martins M, Aveling EL.
Challenges to the improvement of obstetric care in maternity
hospitals of a large Brazilian City: An exploratory qualitative
approach on contextual issues. BMC Pregnancy Childbirth
2018;18:459.
16. Shahidi S, Aghdak P, Farajzadegan Z, Izadi M, Mohammadi M,
Fard MN. Reviewing the effectiveness of pre-pregnancy counseling
protocol on pregnancy and labor indices. Iran J Nurs Midwifery
Res 2011;16:265-72.
17. Mir AM, Pearson S, Shaikh S, Khan M, Masud I, Hussain S.
Maternal mortality due to eclampsia in Khyber Pakhtunkhwa:
Identifying underlying risk factors, and care-seeking behaviours.
J Pak Med Assoc 2019;69:934-8.
18. Janani F, Kohan S, Taleghani F, Ghafarzadeh M. Challenges to
implementing physiologic birth program (PBP): A qualitative
study of midwives opinion in Iran. Acta Medica Mediterranea.
2015;31:1373-80.
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