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Severe acute maternal morbidity

Objective: To test the application of a clinical definition of severe acute maternal morbidity. Design: A one-year prospective descriptive multi-centre study. Setting: Kalafong and Pretoria Academic hospitals, catering for the delivery of indigent women in the Pretoria Health Region. Methods: A 'near-miss' describes a patient with an acute organ system dysfunction, which if not treated. The table below includes the list of 21 indicators and corresponding ICD codes used to identify delivery hospitalizations with SMM. Severe Maternal Morbidity Indicators and Corresponding ICD Codes during. Severe Maternal Morbidity Indicator. DX or PR. ICD-9. ICD-10. ICD-10 short. 1. Acute myocardial infarction Severe maternal morbidity can be thought of as unintended outcomes of the process of labor and delivery that result in significant short-term or long-term consequences to a woman's health. To date, there is not complete consensus among systems and professional organizations as to what conditions should represent severe maternal morbidity AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near miss). METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluate

Severe morbidity and related maternal deaths were standardised per 1000 deliveries. Case definitions exist for each SAMM condition, and all the hospitals have trained data entry clerks. Training and supervision were offered on a continuing basis, and data were verified at headquarters level Severe Maternal Morbidity: Short-term Risks SMM is stressful and affects the woman, her family and friends, and the overall community. For example, women who experience SMM may be at increased risk of post-traumatic stress disorder symptoms during the 6-8 weeks after delivery.22 Single-state studies suggest tha Maternal age ≥ 35 years 22.2 Previous cesarean birth 17.9 Anemia, preexisting 11.8 Gestational diabetes mellitus 9.5 Preterm birth (< 37 weeks) 8.0 Preeclampsia without severe features or gestational hypertension 5.8 Gastrointestinal disease 5.3 Major mental health disorder 4.9 Asthma, acute or moderate/severe 4.8 BMI ≥ 40 kg/m2 4. Severe maternal morbidity (SMM) is variously defined but generally refers to health-impacting and life-threatening events that occur during hospitalization for childbirth. It may precede or be associated with maternal mortality and is more common: there are approximately 70 cases of SMM for each maternal death in the United States [ 1 ]

Severe Acute Maternal Morbidity: A Pilot Study of a

Maternal morbidity can be conceptualized as a spectrum ranging, at its most severe, from a maternal near miss - defined by the World Health Organization (WHO) as the near death of a woman who has survived a complication occurring during pregnancy or childbirth or within 42 days of the termination of pregnancy 5 - to non-life. Severe acute maternal morbidity (SAMM), also known as near miss, is defined as 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 [1, 2].This concept is relatively new in maternal care, but is increasingly becoming important in areas with low maternal mortality ratios or where the geographic area is small [3, 4]

Severe Acute Maternal Morbidity and Postpartum Hemorrhage Criteria for identification of near-miss Case definition Study Related to specific disease Starting point is a specific disease and morbidity is defined for each. For example, pre-eclampsia might be the disease with severe morbidity identified by it severe maternal morbidity, along with developing and carrying out interventions to improve the quality of maternal care are essential to reducing severe maternal morbidity. Data Limitations Depending on the data source, estimates of the national maternal mortality rate may change. This can be due to differences in definitions used and/or data. Diagnosis and Procedure Codes used to define indicators of severe maternal morbidity Severe Maternal Morbidity Indicator Diagnosis or Procedure ICD-9 codes Acute myocardial infarction Diagnosis 410.xx Acute renal failure Diagnosis 584.x, 669.3x Adult respiratory distress syndrome Diagnosis 518.5, 518.81, 518.82, 518.84, 799. The case group comprised 2,500 women with severe acute maternal morbidity (defined by a national expert consensus process) occurring from 22 weeks of gestation and up to 42 days postpartum. A random sample of 3,650 women who gave birth without severe acute maternal morbidity made up the control group Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery)

A recently published nationwide prospective cohort study identified that severe acute maternal morbidity (SAMM) complicates at least 7.1/1,000 pregnancies in the Netherlands 11 The most common indicators of severe maternal morbidity were blood transfusion, disseminated intravascular coagulation (DIC), and hysterectomy (in 2015, 121.1, 11.0, and 11.0 deliveries per 10,000, respectively.) Some conditions often involved procedural intervention

Definitions of SAMM vary, 5 but maternal admission to an intensive-care unit (ICU) is a sensitive and specific indicator of severe maternal morbidity, 6 represents approximately one third of SAMM events, 7, 8 and is a readily identifiable endpoint for audit Most studies on severe acute maternal morbidity describe the causes and characteristics of cases of severe acute morbidity in hospitals, without an immediate link to identifying deficiencies in obstetric care. However, there is some experience with using cases of severe acute maternal morbidity to assess and improve the quality of obstetric care On the other hand, the WHO proposal for surveillance of maternal near-miss (ie severe acute maternal morbidity) recommends the prospective follow-up of severe maternal complications (ie potentially life-threatening conditions) with a view to accurately and comprehensively identifying cases of organ system failure. 28, 29 Some studies attempting. Objective To test the application of a clinical definition of severe acute maternal morbidity. Design A one-year prospective descriptive multi-centre study. Setting Kalafong and Pretoria Academic hospitals, catering for the delivery of indigent women in the Pretoria Health Region. Methods A 'near-miss' describes a patient with an acute organ system dysfunction, which if not treated. Gestational anaemia was significantly more frequent in women with severe acute maternal morbidity (25.3%) than in controls (16.3%), p < 0.001, and mostly mild in both groups

Severe acute maternal morbidity indicators The severe acute maternal morbidity (SAMM) indicators were developed to support the local capture and review of SAMM events and to allow hospitals to monitor and implement safety and quality improvement strategies relating to severe maternal incidents Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time Severe Acute Maternal Morbidity (Near Miss) in a Tertiary Care Center in Maharashtra: A Prospective Study Alka Patankar1, Prashant Uikey2, Neha Rawlani3 1Associate Professor, Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India With declining maternal mortality, the study of severe acute maternal morbidity (SAMM) provides an opportunity to measure the quality of maternal care and to identify ways to improve it. The objective was to study the epidemiology of severe acute maternal morbidity in a high income, rapidly developing, multiethnic country in the Middle East, and to determine the role of ethnicity in maternal.

How Does CDC Identify Severe Maternal Morbidity? CD

RESULTS: The population-based incidence of severe acute maternal morbidity was 6.2% (n=197/3,202, 95% CI 5.3-7.1) in twin pregnancies, and 1.3% (n=2,303/179,107, 95% CI 1.2-1.3) in singleton pregnancies. After controlling for confounders, the risk of severe acute maternal morbidity was higher in twin than in singleton pregnancies (adjusted. Severe maternal morbidity (SMM) is a constellation of pregnancy factors that negatively impact a woman's health. While each of these conditions is rare, SMM occurs 100 times more frequently than maternal death2. Research continues to highlight that nearly one-half of maternal mortality and morbidity is preventable3 and readiness and.

(PDF) Reduction of Severe Acute Maternal Morbidity and

WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health 2004; 1: 3- doi: 10.1186/1742-4755-1-3 pmid: 15357863 . Report on the World Health Organization Working Group on the Classification of Maternal Deaths and Severe Maternal Morbidities Key words: Severe acute maternal morbidity (SAMM), Postpartum period, Tertiary hospital admission. Introduction significant number of maternal morbidities in n South-east Asian and African countries, 8% of the global burden of the disease in women of reproductive age group is attributed to pregnancy and childbirth.

Severe acute maternal morbidity was therefore defined as any one or more of the following: maternal death; severe postpartum hemorrhage defined by need for second line therapy, transfusion ≥4. Engage a trained reviewer/abstractor to complete Part A, the Abstraction Form, including a pertinent synopsis of the event and objective information found in the records. Primary review is then presented to the review committee. Reviews follow a standard format, such as Part B - The assessment form. Review concludes with recommendations

After adjustment, predictors of severe acute maternal morbidity were: duration of hospitalization, number of hospitalizations, and still births, and the most frequent procedures and conditions were blood product transfusions (15.7/1,000), extended stay (9.5/1.000) and severe pre-eclampsia/eclampsia (8.2/1,000) CDC severe maternal morbidity indicators and corresponding ICD-10-CM codes during delivery and postpartum hospitalizations. Severe Maternal Morbidity Indicator. Diagnosis (DX) or Procedure (PR) ICD-10-CM. Acute myocardial infarction. DX. I21.xx, I22.x. Aneurysm. DX. I71.xx, I79.0. Acute renal failure. DX. N17.x, O90.4. Adult respiratory. Maternal health outcomes are categorized, in order of increasing severity, as normal/healthy pregnancy, morbidity (often chronic), severe morbidity, and death. The WHO defines maternal morbidity as any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman's wellbeing. A Dutch study looked at severe acute maternal morbidity (such as admission to intensive care unit, uterine rupture, blood transfusion, etc) and found that women who delivered their first baby at home had the same risk with women delivering at a hospital, but parous women had increased risk of postpartum hemorrhage and blood transfusion.

Severe maternal morbidity is defined as including unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. 1 Often called near-misses, deliveries involving severe maternal morbidity generally include life-threatening conditions, such as acute myocardial infarction, pulmonary. 1 Severe Maternal Morbidity (SMM) refers to conditions and diagnoses that indicate potentially life-threatening maternal complication, including unexpected outcomes of labor and delivery resulting in significant short- or long -term consequences to a woman's health. 2 SMM relates to higher risks of adverse pregnancy outcomes like preterm birth and infant death Background Critical incident audit and feedback are recommended interventions to improve the quality of obstetric care. To evaluate the effect of audit at district level in Thyolo, Malawi, we assessed the incidence of facility-based severe maternal complications (severe acute maternal morbidity (SAMM) and maternal mortality) during two years of audit and feedback Severe acute maternal morbidity is defined as 'a very ill or pregnant or recently delivered woman who would have died had it not been luck or good care was on her side'. 3. Maternal near-miss events provide an opportunity to explore how our healt Introduction Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU)

Severe Maternal Morbidity: Screening and Review ACO

WHO systematic review of maternal morbidity and mortality

Objectives To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Design Cohort study using a linked dataset. Setting Information on all cases of severe acute maternal morbidity in the. Severe obstetric hemorrhage was the main underlying cause of intrapartum or postpartum severe acute maternal morbidity, but the risk for severe acute maternal morbidity from other causes combined was also increased with cesarean delivery, indicating that cesarean delivery-related maternal risks were not limited to bleeding

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Severe acute maternal morbidity: a pilot study of a definition of a near-miss. Penny J. British Journal of Obstetrics and Gynaecology, 01 Apr 1999, 106(4): 397 DOI: 10.1111/j.1471-0528.1999.tb08281.x PMID: 10426249 . This is a comment on Severe acute maternal. Severe Maternal Morbidity(SMM) refers to conditionsand diagnosesthat indicatepotentially life-threateningmaternal complication,includingunexpected outcomes of labor and delivery resulting in significant short- or long-term consequencesto a woman'shealth. 2 SMM relatesto higherrisks of adverse pregnancy outcomes like preterm birth and infant. Little is known about the risk of severe acute maternal morbidity (SAMM) in immigrants as compared to Western women. Therefore, we assessed data related to ethnicity in a large group of women with SAMM and related them to the cohort of all women giving birth in the Netherlands during the study period. Our aim was 2-fold: first, we wanted to. Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the.

Post partum haemorrhage, severe acute maternal morbidity and the condom catheter uterine tamponade G A Ranathunga ¹ 1 Consultant Obstetrician and Gynaecologist Correspondence: G A Ranathunga E-mail: ananda.ran51@gmail.com Competing interests: None Introduction Motherhood is a cherished dream of every woman and most pregnan Keywords: Severe Acute Maternal Morbidity, Pregnancy Complications, Intensive Care. INTRODUCTION Each year nearly 5, 29,000 women die globally due to pregnancy related causes. For each death, nearly 118 women suffer from life threatening events of near miss mortality or Severe Acute Maternal Morbidity The tragedy of maternal deaths has generated several discussions in low-income countries, and any woman who is pregnant is at risk of developing complication. Severe acute maternal morbidity or obstetrics near miss is an event, in which a pregnant woman comes close to maternal death but does not die—a near miss Among these 1834 matched mothers, women with cesarean deliveries had a 1.8 greater odds of severe acute maternal morbidity than those who had vaginal births (adjusted odds ratio [aOR], 1.8). The.

Severe acute maternal morbidity and associated deaths in

Background Although pregnancy-related laparotomy is a major intervention, literature is limited to small case-control or single center studies. We aimed to identify national incidence rates for postpartum laparotomy related to severe acute maternal morbidity (SAMM) in a high-income country and test the hypothesis that risk of postpartum laparotomy differs by mode of birth. Methods In a. The severe maternal outcome ratio (SMOR) and MNM ratio were outcome indicators of maternal morbidity events occurring in the population. Accordingly, during the study period there were 994 deliveries, 993 live births, 94 NM cases, ten maternal deaths, and 165 NM events, giving a mean of 1.7 severe life-threatening morbidities per case Severe maternal morbidity was associated with 6.73 times the mortality risk, compared with no morbidity, during the period from 43 days to 11 months, but this difference dropped to 1.91, 1.77, and 1.18 times the risk, compared with no comorbidity, at 1-4 years, 5-9 years, and 10-29 years, respectively Main Outcomes and Measures Severe maternal morbidity and maternal death during pregnancy and within 6 weeks after termination of pregnancy. Results During the study period, there were 3 162 303 new pregnancies (mean [SD] maternal age, 29.5 [5.6] years) and 3 533 259 related hospital admissions BACKGROUND: Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and.

Severe Acute Maternal Morbidity - Talk by Professor Sarah J. Kilpatrick on 22 February 2017, at University of Otago, Wellington, New Zealan Severe maternal morbidity (SMM) may occur after delivery hospitalization in a significant number of insured women and is most frequent within the first 2 weeks after delivery discharge, according to results from a recent study published in JAMA Network Open.. Researchers advised, therefore, that clinicians assess women for SMM in the postdelivery discharge period because limiting vigilance for. A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project. Eliana Amaral. Related Papers. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo. Abstract. Background: Critical incident audit and feedback are recommended interventions to improve the quality of obstetric care. To evaluate the effect of audit at district level in Thyolo, Malawi, we assessed the incidence of facility-based severe maternal complications (severe acute maternal morbidity (SAMM) and maternal mortality) during two years of audit and feedback

Severe maternal morbidity - UpToDat

Maternal morbidity is a continuum from mild adverse effects to life-threatening events or maternal death (Figure 1). 1 Severe Maternal Morbidity (SMM) refers to conditions and diagnoses that indicate potentiall Review all cases of severe maternal morbidity (ICU admissions and/or transfusions of 4 or more units of red blood cells.2. Implement bundles: hemorrhage, hypertension, etc.3. Have all perinatal staff take implicit bias training.6. Utilize toolkits.4. Have a massive transfusion protocol and hemorrhage kit on L+D.5 Obstetrical hemorrhage is a leading cause of severe maternal morbidity, a key indicator of a nation's healthcare delivery system and often associated with a high rate of preventability. Limited data suggest that a patient's hemorrhage risk score may be associated with risk for maternal morbidity such as severe hemorrhage, intensive care unit admission, or transfusion Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM]and maternal death at tertiary health care centre; Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM]and maternal death at tertiary health care centre. Authors . Rabia Syeda Perveen, Fauzia Shukur Uddin, Shazia Tabussum, Rumin Severe acute 18 maternal morbidity, which would be a consequence of major haemorrhage, was rated as an 19 important outcome. Women's acceptability of and satisfaction with intervention were also 20 rated as important outcomes because the committee wanted to support women-centred care

WHO Measuring maternal health: focus on maternal morbidit

Results were similar when excluding severe maternal morbidity cases with transfusion alone. After accounting for maternal risk factors, the black-white relative risk for severe maternal morbidity excluding transfusion alone was reduced from a baseline of 1.33 (95% confidence interval, 1.16-1.52) to 0.99 (0.76-1.29) in the postintervention period Severe maternal morbidity rates are 63% higher among women from mostly Black communities than women from majority white communities, a new Blue Cross Blue Shield Association report finds. In the.

Severe Acute Maternal Morbidity in Twin Compared With

Severe Maternal Morbidity and Risk of Mortality Beyond the

Severe acute maternal morbidity and mode of delivery in

  1. Death is obviously the most serious consequence of maternal morbidity for women, yet maternal morbidity can lead to other severe consequences. Maternal morbidities can be acute, occurring during childbirth and immediately thereafter, or chronic, lasting for months or years
  2. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynaecol 1998; 105:985. Ozimek JA, Eddins RM, Greene N, et al. Opportunities for improvement in care among women with severe maternal morbidity
  3. Introduction: Severe acute maternal morbidity (SAMM) emerges as a new quality indicator of obstetrical care. The investigation of severe maternal morbidity (SAMM) and associated risk factors is important for the global reduction of maternal mortality. Aims and Objectives: To study the incidence, demographic factors associated with SAMM, different clinical insults responsible for SAMM.
  4. Unlike maternal mortality in developed countries it has been reduced in recent years and, therefore, the analysis of acute maternal morbidity It has been added to confidential investigations into the causes of maternal deaths. The main disadvantage at this time is the lack of universal definitions of severe acute maternal morbidity
  5. Severe Acute Maternal Morbidity (SAMM) form Reporting criteria: all women who were pregnant or had delivered within the past 42 days, who were admitted to an adult ICU. Relevant information detailed below and findings from the hospital review should be forwarded t
  6. Women whom ultimately die, however, rarely transition directly from a healthy state to death but rather progress along a continuum from health through severe morbidity to death. 10 Further, severe maternal morbidity (SMM) occurs almost 100 times more frequently than maternal death, affecting more than 60,000 women per year or 1.5% of all.

Trends and Disparities in Delivery Hospitalizations

Severe acute maternal morbidity (SAMM) is defined as a very ill pregnant or recently delivered woman who would have died had it not been that luck or good care was on her side. 1 Assessment of SAMM cases is increasingly used to complement maternal mortality review in developed countries and analysis of morbidity has become a main topic in quality of care issues in maternity care. 2,3 The. Several studies, both from developed and developing countries, and a recent expert review highlight the negative impact of anemia during pregnancy on maternal and neonatal outcomes, including life-long effects of iron-deficiency on the neonate. 1-4,7-10,13,14 However, data examining the contribution of anemia to severe maternal morbidity. Severe maternal morbidity in a large cohort of women with acute severe intrapartum hypertension Clinical morbidities, trends, and demographics of eclampsia: a population-based study Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate car Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011 severe maternal morbidity, the delivery was counted in both categories. Figure 1. Trends in delivery hospitalizations involving severe maternal morbidity , 2006-2015 . a. If a delivery involved blood transfusion and 1 of the other 20 types of severe maternal morbidity, the delivery was counted in both categories

Preventability of severe acute maternal morbidity

Severe acute maternal morbidity in low-income countries

Severe maternal morbidity surveillance: Monitoring

  1. istrative data from 2002 to 2015 in Western Australia. Participants Women with 410 043 birth events (includes all births from the same pregnancy.
  2. The risk of severe acute maternal morbidity was higher in twin than in singleton pregnancies when adjusting for confounding variables (adjusted odds ratio, 4.2). Findings were for both antepartum and intrapartum or postpartum, and regardless of the causal condition (severe hemorrhage, severe hypertensive complications, or other conditions)
  3. Severe maternal morbidity (SMM) by Race and Ethnicity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. Based on 20 ICD 10 codes as defined by the CDC

Severe acute maternal morbidity: a pilot study of a

BACKGROUND: Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated Appendix: Wisconsin and US Rates by Individual Maternal Morbidities Severe maternal morbidity rates for delivery hospitalizations, Wisconsin and United States (per 10,000 delivery hospitalizations) Maternal morbidity ICD-9 codes Wisconsin (2010-2014) United States* (2008-2009) Acute myocardial infarction 410.xx 0.1 0. Methods. We identified cases of severe maternal morbidity and comparison women through the monthly UKOSS mailing between February 2005 and February 2006.10 We asked clinicians to report any woman diagnosed with acute fatty liver of pregnancy, amniotic fluid embolism, antenatal pulmonary embolism, eclampsia, or peripartum hysterectomy. The UKOSS methodology has been described in detail.

Gestational anaemia and severe acute maternal morbidity: a

  1. Pregnant women were also at substantially greater risk of sepsis or shock, needing mechanical ventilation, and acute respiratory distress syndrome. In fact, rates of overall severe maternal morbidity and of influenza-related complications have increased in maternal patients with influenza by more than 200% from 2000 to 2015
  2. Incidence of severe acute maternal morbidity was 6.34 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union. Decreasing of caesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic
  3. Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. A cross-sectional study with record review was conducted in 2014
  4. Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study. Diane Korb, Thomas Schmitz, Aurélien Seco, François Goffinet, Catherine Deneux-Tharaux, JUmeaux MODe d'Accouchement (JUMODA) study group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG).
  5. Audit of severe acute maternal morbidity (SAMM) is increasingly perceived as a useful complementary [6]. However, despite their widespread institutionalization, empirical evidence for benefits of audit and feedback remains limited [4,5]. Especially in low-resource countries, which carry by far the highest burden of maternal mortality and.
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