A systematic review of maternal near miss and mortality due to postpartum hemorrhage

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Postpartum hemorrhage (<jats:styled-content style="fixed-case">PPH</jats:styled-content>) is the principal direct cause of maternal mortality worldwide. Analysis of maternal near miss could increase understanding of survival among women with life‐threatening <jats:styled-content style="fixed-case">PPH</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To determine the near‐miss ratio and maternal mortality index for <jats:styled-content style="fixed-case">PPH</jats:styled-content> globally.</jats:p></jats:sec><jats:sec><jats:title>Search strategy</jats:title><jats:p>A prevalence systematic review was conducted of English‐language articles published from 1995 to 2014. Suitable articles were identified from the Scopus, PubMed, Embase, and Grey Literature databases. The main search terms used were “maternal near‐miss” and “severe acute maternal morbidity.”</jats:p></jats:sec><jats:sec><jats:title>Selection criteria</jats:title><jats:p>Near‐miss studies and audits describing the severe maternal outcome rate for <jats:styled-content style="fixed-case">PPH</jats:styled-content> were included.</jats:p></jats:sec><jats:sec><jats:title>Data collection and analysis</jats:title><jats:p>Data were extracted from eligible publications. Quantitative analysis and narrative synthesis were used.</jats:p></jats:sec><jats:sec><jats:title>Main results</jats:title><jats:p>For 26 included studies, the median near‐miss ratio for <jats:styled-content style="fixed-case">PPH</jats:styled-content> was 3 per 1000 live births. The mortality index for <jats:styled-content style="fixed-case">PPH</jats:styled-content> was 6.6% (range 0.0%–40.7%). The mortality index was highest in low‐income countries and lower middle‐income countries. Overall, <jats:styled-content style="fixed-case">PPH</jats:styled-content> was the most frequent contributor to obstetric hemorrhage, with atonic uterus identified as the main cause.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Women in low‐income countries and lower middle‐income countries have an increased likelihood of severe <jats:styled-content style="fixed-case">PPH</jats:styled-content> and of dying from <jats:styled-content style="fixed-case">PPH</jats:styled-content>‐related consequences.</jats:p></jats:sec>