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BioMed Research International
Volume 2014, Article ID 989815, 10 pages
Research Article

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

1Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), R. Alexander Fleming 101, P.O. Box 6030, 13083-881 Campinas, SP, Brazil
2Centre for Research on Reproductive Health of Campinas (Cemicamp), R. Vital Brasil 200, 13083-888 Campinas, SP, Brazil
3Federal University of Amazonas, Manaus, AM, Brazil
4CISAM, School of Medical Sciences, Recife, PE, Brazil
5Federal University of Ceará, Fortaleza, CE, Brazil
6Federal University of Bahia, Salvador, BA, Brazil
7Hospital Geral Cesar Cals, Fortaleza, CE, Brazil
8Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
9Maternidade Odete Valadares, Belo Horizonte, MG, Brazil
10Hospital Materno Infantil, Goiania, GO, Brazil
11IMIP, Recife, PE, Brazil
12Federal University of Pernambuco, Recife, PE, Brazil
13Federal University of Campina Grande, PB, Brazil
14Federal University of Maranhão, São Luis, MA, Brazil
15Federal University of Paraná, Curitiba, PR, Brazil
16Federal University of Paraíba, João Pessoa, PB, Brazil
17Hospital Maternidade Fernando Magalhães, Rio de Janeiro, RJ, Brazil
18Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
19Hospital Maternidade Celso Pierro, Campinas, SP, Brazil
20Instituto Fernandes Figueira, Rio de Janeiro, RJ, Brazil
21Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
22University of the State of São Paulo, Botucatu, SP, Brazil
23Jundiaí School of Medicine, Jundiaí, SP, Brazil
24University of São Paulo, Ribeirão Preto, SP, Brazil
25Santa Casa de Limeira, Limeira, SP, Brazil
26Santa Casa de São Carlos, SP, Brazil
27Maternidade Leonor Mendes de Barros, Sao Paulo, SP, Brazil
28Federal University of São Paulo, SP, Brazil

Received 27 April 2014; Revised 17 June 2014; Accepted 17 June 2014; Published 23 July 2014

Academic Editor: Sohinee Bhattacharya

Copyright © 2014 Samira Maerrawi Haddad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (), delays related to quality of medical care (), absence of blood derivatives (), difficulties of communication between health services (), and any delay during the whole process (). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.