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Low Incidence of Maternal Near-Miss in Zhejiang, a Developed Chinese Province: A Cross-Sectional Study Using the WHO Approach

Authors Ma Y, Zhang L, Wang X, Qiu L, Hesketh T, Wang X

Received 23 December 2019

Accepted for publication 1 April 2020

Published 29 April 2020 Volume 2020:12 Pages 405—414


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Vera Ehrenstein

YuanYing Ma,1 LiSan Zhang,2 Xian Wang,3 Liqian Qiu,1 Therese Hesketh,4,5 Xinyu Wang6

1Department of Women’s Healthcare, Women’s Hospital, Zhejiang University School of Medicine, Zhejiang Province, People’s Republic of China; 2Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, People’s Republic of China; 3Department of Big Data Analysis, Hangzhou Maicim Medical Technology Co., Ltd, Zhejiang Province, People’s Republic of China; 4Centre for Global Health, Zhejiang University, Zhejiang Province, People’s Republic of China; 5Institute for Global Health, University College London; London, UK; 6Department of Obstetrics and Gynaecology, Women’s Hospital, Zhejiang University School of Medicine, People’s Republic of China

Correspondence: Xinyu Wang; Therese Hesketh Email;

Background and Aim: Maternal near-miss (MNM) surveillance has been developed to identify severe complications in pregnancy since 2011 in China. However, very little is known about MNM in China. This study aims to explore the prevalence of MNM, the risk factors, and perinatal outcomes using the WHO near-miss approach in a developed Chinese province.
Materials and Methods: We used data from China’s National Maternity Near Miss Obstetrics Surveillance System for the period  2012 to 2017, which included 18 hospitals in Zhejiang Province. Chi-squared tests were used to compare the socio-demographic factors, obstetric complications and perinatal outcomes between women with and without MNM. Logistic regression was used to examine the independent risk factors for MNM.
Results: A total of  612,264 pregnant women were recruited. There were 3208 MNM cases and 34 maternal deaths. The MNM incidence ratio was low at 5.9 per 1,000 live births, with an MNM mortality ratio of 98:1 and mortality index of 1.1%. Among 3208 women with MNM, postpartum hemorrhage was the commonest cause at 76.3% followed by severe anemia at 23.7% and placenta previa at 23.0%. Embolism was identified as having the highest risk for MNM (AOR 46.0; 95% CI 19.1– 110.7), followed by postpartum hemorrhage (AOR 41.0; 95% CI 35.7– 47.0), and severe anemia (AOR 36.6; 95% CI 16.0– 84.1). MNM cases were significantly associated with severe perinatal outcome, including premature birth, low birth weight, multiple fetuses, stillbirth rates and neonatal mortality.
Conclusion: Overall near-miss indicators suggested a relatively high quality of maternal health care in a developed province of China. The identified risk factors may be helpful in developing targeted interventions for improving maternal safety.

Keywords: maternal near-miss, adverse perinatal outcomes, clinical audit, high-risk pregnancy, pregnancy complication

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