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. 2021 Aug 30;99(10):693–707F. doi: 10.2471/BLT.21.285945

Table 2. Incidence and causes of maternal near miss in middle-income countries.

Author Setting No. of live births No. of cases of maternal near miss Maternal near misses per 1000 live birthsa Most frequent organ dysfunction Most frequent cause of maternal near missb No. of maternal deaths Maternal deaths per 100 000 live birthsc Ratio of maternal near miss to maternal deathd Mortality index, %e
Lower-middle-income countries
Ps et al., 201353 India 7 330 131 17.9 NR Haemorrhage 23 313 5.6 14.9
Tunçalp et al., 201336 Ghana 3 206 94 28.6 Coagulation or haematological dysfunction Severe postpartum haemorrhage 37 1 154 2.5 28.2
Kaur et al., 201443 India 6 008 140 23.3 NR Hypertensive disorders 16 266 8.8 10
Kushwah et al., 201448 India 5 219 63 6.8 NR Hypertensive disorders 47 901f 1.3 42.9
Luexay et al., 201461 Lao People's Democratic Republic 1 123 11 9.8 Respiratory Haemorrhage 2 179 5.5 15.3
Nacharajuh et al., 201455 India 2 385 22 9.2 NR Pre-eclampsia 2 84f 11.0 8.3
Pandey et al., 201442 India 5 273 633 120.0 NR Haemorrhage 247 45 2.6 27.2f
Bakshi et al., 201531 India 688 51 74.1f NR Sepsis 10 1 5.1 16.4
Bashour et al., 201583 Egypt 2641 32 12.1 Coagulation or haematological dysfunction Haemorrhage 3 114 11.0 8.6
Mazhar et al., 201566 Pakistan 12 729 94 7.0 Cardiovascular Postpartum haemorrhageg 38 299 2.5 28.7
Sangeeta et al., 201527 India 6 767 27 4.0 Coagulation or haematological dysfunction Haemorrhage 13 188f 3.4 22.8
Abha et al., 201649 India 13 895 211 15.2 Coagulation or haematological dysfunction Hypertensive disorders 102 734f 2.1 32.9
Ansari et al., 201665 Pakistan 1 035 76 73.4f Cardiovascular NR 7 676 10.9f 8.4f
De Mucio et al., 201630 Honduras 613 10 16.3f NR NR 1 163 10.0 9.1f
De Mucio et al., 201630 Nicaragua 477 4 8.4f NR NR 0 0 0 0
Kulkarni et al., 201650 India 14 508 525 36.2 Coagulation or haematological dysfunction Hypertensive disorders NR 648f 5.6 9.6
Oladapo et al., 201662 Nigeria 91 724 1451 15.8 NR Obstetric haemorrhage 998 1 088 2.5f 40.8
Parmar et al., 201635 India 1 929 40 20.7 NR NR 2 933 2.2 31.0
Rathod et al., 201651 India 22 092 167 7.6 Coagulation or haematological dysfunction Haemorrhage 66 298 3.4 29.7
Ray et al., 201633 India 4 038 218 54.0 NR Hypertensive disorders 17 421 13.0 7.17
Tanimia et al., 201640 Papua New Guinea 13 338 121 9.1 NR Obstetric haemorrhage 9 67 13.5 6.8
Bolnga et al., 201768 Papua New Guinea 6 019 153 25.4 NR Postpartum haemorrhage 10 166 15.3 6.8
Chandak & Kedar, 201752 India 12 757 137 10.7 Cardiovascular Eclampsia NR 243f 10.5 18.5f
Mbachu et al., 201728 Nigeria 262 52 198.0 NR Hypertensive disorders 5 1 908 11.4 8.8
Tallapureddy et al., 201756 India 3 784 32 8.5 Coagulation or haematological dysfunction Haemorrhage 6 159f 5.3 15.8
Oppong et al., 201947 Ghana 8 433 288 34.2 Cardiovascular Pre-eclampsia and eclampsiah 62 735 4.6f 21.7f
Panda et al., 201832 India 1 349 89 66.0 NR Severe pre-eclampsia 8 593 11.1 8.2
Reena & Radha, 201854 India 3 451 32 9.3 Coagulation or haematological dysfunction Severe pre-eclampsia 5 145 6.4 13.5f
Chaudhuri & Nath, 201957 India 4 081 175 43.0 Vascular dysfunction Hypertensive disorder (eclampsia) 23 564 7.7 11.5
Chhabra et al., 201958 India 38 111 261 6.9 Coagulation Hypertensive disorder 166 436 1.6 23
El Agwany, 201946 Egypt 28 877 170 5.9 Coagulation Haemorrhage 14 50f 12.2 7.5
Gabbur et al., 201959 India 6 053i 100 16.4 NR Postpartum haemorrhage 13 215f 7.7 88.5f
Herklots et al., 201969 United Republic of Tanzania 22 011 256 11.6 Coagulation or haematological dysfunction NR 79 359 3.2 24.0
Jayaratnam et al., 201971 Timor-Leste 4 529 39 8.0 NR Eclampsia or postpartum haemorrhage 30 662 1.3 43.0
Mansuri & Mall, 201960 India 21 491 247 11.5 NR Eclampsia or pre-eclampsia 79 367 3.1 24.2
Karim et al., 202067 Pakistan 3 360 54 16.0 NR Adherent placenta 8 238 6.8 12.9
Lilungulu et al., 202070 United Republic of Tanzania 3 480 124 36.0 NR Haemorrhage 16 460 7.8 11.4
Owolabi et al., 202022 Kenya 36 162 260 7.2 NR Postpartum haemorrhage 13 36 20.0 4.8
Samuels & Ocheke, 202064 Nigeria 2 357 86 36.5f NR Hypertensive disorders 19 806 4.5 81.9f
Ugwu et al., 202063 Nigeria 2 236k 60 26.8f Cardiovascular Severe haemorrhage 28 1251 2.1 31.8
Upper-middle-income countries
Cecatti et al., 201124 Brazil 14 418 194 13.5 NR NR 18 125 10.7 8.5
Morse et al., 201123 Brazil 1 069 10 9.4 NR Severe pre-eclampsiag 3 280 3.3 23
Lotufo et al., 201225 Brazil 9 683 43 4.4 NR Haemorrhage 5 52 8.6 10.4
Jabir et al., 201382 Iraq 25 472 129 5.1 Cardiovascular Obstetric haemorrhage 16 63 9.0 11.0
Shen et al., 201326 China 18 104 72 4.0 NR Postpartum haemorrhage 3 16 23.0 4.2
Dias et al., 201472 Brazil 23 894 243 10.2 NR NR 7 29 34.7 2.8
Galvão et al., 201474 Brazil 16 243 76 4.7 NR Hypertensive disordersj 17 105 4.5 18
Bashour et al., 201583 Lebanon 1 171 5 4.3 Hepatic dysfunction Multiple causesk 0 0 0 NR
Madeiro et al., 201575 Brazil 5 841 56 9.6 NR Hypertensive disorders 10 171 5.6 15.2
Naderi et al., 201580 Islamic Republic of Iran 19 908 501 25.2 NR Severe pre-eclampsia 2 10f 250.0 NR
Oliveira & Da Costa, 201576 Brazil 19 940 255 12.8 NR Hypertensive disorders NR 280f 4.5 18
Soma-Pillay et al., 201537 South Africa 26 614i 114 4.3f Vascular Obstetric haemorrhage NR 71f 7.1f 14
Cecatti et al., 201673 Brazil 82 144 770 9.37 NR Hypertensive disorders 140 170 5.5 15.4
De Mucio et al., 201630 Colombia 334 3 9.0f NR NR 0 0 0 0
De Mucio et al., 201630 Dominican Republic 133 3 22.6f NR NR 0 0 0 0
De Mucio et al., 201630 Ecuador 228 2 8.9f NR NR 0 0 0 0
De Mucio et al., 201630 Paraguay 334 2 6.0f NR NR 1 299f 2.0f 33.3f
De Mucio et al., 201630 Peru 315 11 35.0f NR NR 0 0 0 0
Ghazivakili et al., 201681 Islamic Republic of Iran 38 663 192 5.0 Cardiovascular Severe pre-eclampsia NR 18f 2.4 3.5
Mohammadi et al., 201639 Islamic Republic of Iran 12 965 82 6.3 Coagulation or haematological dysfunction Severe postpartum haemorrhage NR 93f 6.9f 13
Norhayati et al., 201629 Malaysia 21 579 47 2.2 Coagulation or haematological dysfunction Postpartum haemorrhage NR 9f 23.5 4.1
Akrawi et al., 201741 Iraq 17 353 142 8.2f Cardiovascular Hypertensive disorders 11 63 12.9 7.2
Iwuh et al., 201844 South Africa 19 222 112 5.8 NR Hypertensive disorders 13 68 8.6 10.4
Oliveira Neto et al., 201877 Brazil 8 065 60 7.4 Hepatic dysfunction Pre-eclampsia NR 62f 13.0 7.7f
De Lima et al., 201934 Brazil 1 002 55 54.8 Respiratory Hypertension 1 99 11.0 8.3
Mu et al., 201979 China 9 051 638l 37 060 4.1f Coagulation dysfunction Hypertensive disorders 380 4.1f 97.5 NR
Heemelaar et al., 202038 Namibia 37 106 298 8.0 NR Obstetric haemorrhage 23 62 13.0 92.8f
Ma et al., 202078 China 542 109 3208 5.9 Coagulation or haematological dysfunction Postpartum haemorrhage 34 6.3 94.4f 1.1
Verschueren et al., 202045 Suriname 9 114 71 7.8 Coagulation or haematological dysfunction Hypertensive disorders 10 110 7.1f 12.0

NR: not reported.

a Maternal near miss ratio.

b Most frequent causes of maternal near miss; terminology as used in the original article.

c Maternal mortality ratio.

d Ratio of number of maternal misses to the number of maternal deaths.

e Mortality index is: [number of maternal deaths / (number of cases of maternal near miss + number of maternal deaths) × 100].

f We calculated the value shown using formulae shown in the main text.

g Severe maternal outcome.

h Potentially life-threatening conditions.

i Per number of births.

j Severe acute maternal morbidity.

k Multiple causes: placenta praevia, placenta accreta, placenta increta, placenta percreta, hepatic disease.

l Number of pregnant women.