This document summarizes presentations on maternal near miss in Sudan. It defines maternal near miss as a severe life-threatening complication during pregnancy, childbirth, or postpartum that requires urgent intervention to prevent death. The document discusses how analyzing near miss cases can provide insights into health system failures in obstetric care. It notes that the leading causes of near miss in Sudan are hemorrhage, infection, hypertensive disorders, and anemia. The document also outlines Sudan's policy on identifying near miss criteria and qualitative research examining determinants of maternal morbidity and mortality in post-conflict areas.

1. MATERNAL NEAR MISS IN SUDAN
Geneva Foundation for Medical Education and Research
GFMER Sudan 2012
Forum No: ( 1 )

2. Name of presenters
Name Position Institution
Aida Ahmed Head, Department Obstetrics & UMST
Gynaecology Nursing
Amal Khalil Coordinator, Reproductive & Child UMST
Health Research Unit
Name of contributors
Name Position Institution
Aida Ahmed Head, Department Obstetrics & UMST
Gynaecology Nursing
Amal Khalil Coordinator, Reproductive & Child UMST
Health Research Unit

3. Contents of the presentation
1. Definition
2. Maternal morbidity rate
3. Health system failures in relation to obstetric
care
4. MDGs
5. Severe life threatening obstetric complication
6. Sudan policy and identification criteria for near
miss

4. Maternal Near Miss is:
 a severe life threatening obstetric complication
necessitating an urgent medical intervention in order to
prevent likely death of the mother.
 any pregnant or recently delivered woman, in whom
immediate survival is threatened and who survives by chance
or because of the hospital care she received.
 Women who experienced and survived a severe health
condition during pregnancy, childbirth or postpartum are
considered as near miss or severe acute maternal morbidity
(SAMM) cases.

5. Why maternal near miss?
two decades ago.
In low maternal mortality
settings
morbidity useful
indicator of obstetric care
in recent years analyzing near
miss/SAMM cases
understanding health system
failures in
relation to obstetric care

6. Why maternal
near miss?
 Near miss/SAMM cases share many characteristics
with maternal deaths and can directly inform on
obstacles that had to be overcome after the onset of an
acute complication.
 Corrective actions for identified problems can be
taken to reduce related mortality and long-term
morbidity.

7. Moreover, countries are increasingly adopting policies that
encourage births in institutions. Instruments must therefore,
be available to assess the quality of care within the
institutions. Routine assessments of maternal near miss
cases will help answer that need.

8. It is expected that the implementation of the
maternal near miss process provide an important
contribution to assessing and improving quality of
obstetric care and to the reduction of maternal
deaths.

9. The advantages
 The care of critically ill women will be analyzed, not only
deaths. This is important given the emphasis that emergency
obstetric care is currently receiving, and allows for monitoring
the quality of these programs.
 A proportion of women with life-threatening conditions
survive. They can be interviewed and areas of breakdown in
the health system can be identified.
 Indicators of maternal near miss and maternal deaths as
exemplified in can allow for comparison between institutions
and countries and changes over time.

10. maternal morbidity rate
Medical complications in a woman
caused by
pregnancy , labor , or delivery

11. severe life threatening
obstetric complication
 Obstetric Haemorrhage
 Eclampsia
 Sepsis
 Pulmonary embolism
 Ruptured uterus
 Anemia related conditions & Heart Failure
 Abortion
 Malaria
 Anesthesia
 Amniotic fluid embolism
 ruptured ectopic pregnancy
 Fever and convulsions
Jaundice

12. 5th MDG
is calling
for improving maternal health
World wide.

13. Sudan policy and identification
criteria for near miss

14. Health system failures in
relation to obstetric care

15. Maternal near-miss in a rural hospital in Sudan
 The first report of maternal near-miss in Sudan
 Medical files of pregnant women and who
delivered recently at Kassala Maternity
Hospital from January 2008 to December 2010
were studied.

16. Results
 Hemorrhage (40.8%)
 Infection (21.5%),
 Hypertensive disorders (18.0%),
 Anaemia (11.8%)

17. Conclusion
 high frequency of maternal morbidity and
mortality at the level of this facility. Therefore
maternal health policy needs to be concerned
not only with averting the loss of life, but also
with preventing or ameliorating maternal-
near miss events (hemorrhage, infections,
hypertension and anemia) at all care levels
including primary level.

18. Qualitative Study
Determinants of maternal morbidity and
mortality in post conflict areas.

19. Aim
 to gain in-depth understanding of the
interacting determinants behind maternal
mortality
 to investigate the methods of survival of
maternal near miss in crises without
professional health care.

20. Method
 Qualitative study design using Critical Incident
Technique [CIT].
 11 near miss events.
 Interviews were conducted with husbands,
mothers, in laws, sisters, midwives of the
deceased and in case of survival the maternal
near misses.

21. Results
 Socio-demographic: education, family, age at
marriage, poverty
 Cultural: perceptions about pregnancy and
delivery
 Health facilities: willingness to pay,
unacceptability
 Conflict/ post conflict: fear, insecurity, weak
infrastructure, lack of transportation.

22. Their stories…
Maternal Near Miss PPH

23. A house-wife & mother of four children
started her story “It happened 5 years ago.
First of all I had pain in my tummy/belly. I
sent my mother to the village midwife. I
never deliver by a traditional birth
attendant ever. The VMW examined me &
said this is labour! We waited for 2 hours
but the baby didn’t come& after 3 hours
the baby came. I delivered & the bleeding
started & the placenta didn’t come out”.

24. She was rolling in pain, bleeding and started to get
weak and restless. By then her husband decided to take
her to Renk. It was the rainy season autumn; he went
to fetch a car. Luckily he found a pickup truck
immediately that charged a ridiculous amount of
money SDG100. It was a long and bumpy trip on the
dirt road to Renk taking them 4 hours to reach the
hospital from their village Gabarona.
The minute she entered the maternity ward safely
delivered the placenta. She was discharged after a
week diagnosed as having Malaria and was on
medication.
Later on they moved to Renk where she went to
antenatal care/ follow up and delivered her children at
the hospital.

25. THANKS