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

Background Postpartum hemorrhage (PPH) is the principal direct cause of maternal mortality worldwide. Analysis of maternal near miss could increase understanding of survival among women with life‐threatening PPH. Objectives To determine the near‐miss ratio and maternal mortality index for PPH globally. Search strategy 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.” Selection criteria Near‐miss studies and audits describing the severe maternal outcome rate for PPH were included. Data collection and analysis Data were extracted from eligible publications. Quantitative analysis and narrative synthesis were used. Main results For 26 included studies, the median near‐miss ratio for PPH was 3 per 1000 live births. The mortality index for PPH was 6.6% (range 0.0%–40.7%). The mortality index was highest in low‐income countries and lower middle‐income countries. Overall, PPH was the most frequent contributor to obstetric hemorrhage, with atonic uterus identified as the main cause. Conclusions Women in low‐income countries and lower middle‐income countries have an increased likelihood of severe PPH and of dying from PPH‐related consequences. PPH is a leading contributor to maternal deaths. The near‐miss rate for PPH was three per 1000 live births; the maternal mortality index was 6.6%.