Maternal Near Miss as health care indicator: an integrative review

Objective: The objective was to make a synthetic and descriptive compilation of the results of scientific studies addressing maternal near miss. Methods: A search was conducted in the databases of the Electronic Scientific Library Online (SciELO), Latin American and Caribbean Literature (LILACS) and International Literature in Health and Biomedical Sciences (PubMed),in the period from 2011 to June 2016, with the descriptors “maternal near miss” and “severe maternal morbidity” and their representations in Portuguese and English. After the exclusion of duplicate texts, the reading of the abstracts and the analysis by validated instrument, this review comprised 28 publications. Results: The studies indicate clinical determinants directly related to the occurrence of maternal near miss, among which, these stand out: high-risk gestation; hospitalizations during pregnancy; clinical comorbidities, mainly severe hypertension, infections and hemorrhage; cesarean delivery; use of forceps and need for ICU admission. Conclusion: In addition to the clinical determinants, the studies point out that socioeconomic and healthcare factors are directly related to the occurrence of maternal near miss, which makes it a viable tool for evaluation of the quality of the healthcare service and the impact of public policies aimed at improving maternal health and reducing social inequities. Early detection and provision of emergency obstetric care are essential to reduce maternal near miss and mortality rates.