Systematic review on the incidence and prevalence of severe maternal morbidity.

OBJECTIVE To summarize the prevalence and the incidence of serious morbidity from studies reporting data on severe maternal morbidity and to compare study designs and definitions. METHODS A literature search was used to identify relevant studies, which report data on prevalence/incidence of severe complications during pregnancy, delivery and postpartum. For assessment of the quality of studies a structured data collection form from World Health Organization for systematic review of maternal mortality and morbidity was used. Incidence/prevalence and case-fatality ratios were extracted. RESULTS In this review 24 studies were included, most of them--cross-sectional hospital based (16/24). In ten studies data about one severe maternal condition (admissions to intensive care unit, and hysterectomy) was presented, while fourteen studies dealt with multiple causes of severe maternal morbidity (rupture of uterus, hemorrhage, sepsis, and hypertensive disorders of pregnancy). In these studies very different inclusion criteria due to structure of diseases and severity were used. CONCLUSIONS The prevalence of severe maternal morbidity ranged from 0.07-8.23% and the case-fatality ratio from 0.02-37%. Studies estimating the incidence of severe maternal morbidity have used different definitions and ways of identification. Severe hemorrhage, sepsis and hypertensive disorders of pregnancy are the commonly used "near-miss" conditions. Further work will be able to create clear definition and method of identification.