2. DEFINITION
A very ill pregnant or recently delivered woman who would have died
had it not been that luck and good care was on her side
3. WHO APPROACH FOR SAMM
Disease specific criteria
eg for PPH,PE,E,SEPSIS,rupture uterus,c/c of abortions
-less specific but has adv
1.Easy to interpret
2.Cases can be identified retrospectively
3.Quality of care for that particular disease can be assessed.
disadv-if MODS,where to put
4. Management/intervention based criteria
Adv-sinple to identify the cases
Disadv-
1.Depends on many other variables such as availability of beds,facilities
in ICU,differing views about and indications of a
treatment,eg,hysterectomy
2.Does not include all SAMM cases
5. ORGAN SYSTEM BASED CRITERIA
-allows for identifying all severe morbidities and then investigating the
primary cause,thus does not discard any particular condition
-most reproducible across similar areas
-criteria can be defined according to resources available.
-high technology requiring laboratory and haemodynamic
investigations can be avoided
Disadv
-most labor intensive for identifying cases, hence criteria for inclusion
as near miss must be strict
-bias can be introduced if data collection is incomplete and prevalence
can be underestimated. ......cont
10. INDICATORS OF SAMM(RATIOS)
1.SEVERE MATERNAL OUTCOME RATIO(SMOR)
Number of women with life-threatening conditions(near miss+maternal
deaths)per 1000 live births
2.MNM(maternal near miss) Ratio(MNMR)
Number of maternal near miss cases per 1000 lb
3.MATERNAL NEAR MISS MORTALITY RATIO
Ratio between maternal near miss and maternal deaths
4.MORTALITY INDEX
Number of maternal deaths divided by number of women with life
threatening conditions
11. IMPORTANCE OF ANALYSIS OF SAMM
1.Study of SAMM cases given an idea about its magnitude, to identify
most frequent characteristics and clinical conditions which will help to
recognize problems in antepartum services,peripheral healthcare
facilities and referral system
2.Underlying diseases causing SAMM are same as those causing
maternal mortality. Therefore studying the circumstances surrounding
a woman with SAMM will act as a complement to analysis of maternal
mortality and will allow for a rapid assessment of maternal care.
3.It also allows to know the social,cultural, economic and political
determinants of health. These factors can operate at three levels
leading to delay in getting appropriate treatment PTO
12. -delay in deciding to seek care(phase 1 delay)
-delay in identifying and reaching care(phase 2 delay)
-delay in receiving appropriate care in hospital (phase 3 delay)
4.A study of the most frequent preventable factors can suggest changes
in clinical education programmes and policies to improve maternal
outcome
5.A continuous psychosocial follow up of those survived is necessary as
their longterm health related quality of life is impaired.
6.Audit of SAMM cases help us to understand the spectrum from
maternal morbidity to mortality.
13. In the question shivani asked,the criteria was asked.
WHO is the most commonly criteria,
Rest u can just mention.
indicators of SAMM are v imp,the ratios.
Importance of analysis,u can add more if u want.i have put the best
