Near miss maternal: influencing factors and guidelines for reducing maternal morbidity and mortality




Maternal Mortality; Morbidity; Maternal Health; Near Miss, Healthcare; Nursing.


Objective: to analyze the scientific evidence about the factors influencing maternal near miss cases and possible guidelines for reducing maternal morbidity and mortality. Methods:integrative review with 2895 articles found and 17 selected articles. Results: the factors influencing the near miss cases were: delays in obstetric care; unprepared health team; precarious conditions of services; limited availability of blood derivatives; and prenatal disability, the limited use of evidence-based practices and audits. As main directions to minimize these events, we have evidenced: to strengthen the network of reference and counter-reference; carry out professional training; improve prenatal coverage; and invest in infrastructure, process management and clinical audits. Conclusion: the factors that influence the maternal near miss cases range from delayed care to failure to perform prenatal care, whose management improvement is the main direction.


Fernandes BB, Nunes FBBF, Prudêncio PS, Mamede FV. Epidemiological research of the maternal deaths and compliance with the fifth millennium development goal. Rev Gaúcha Enferm. 2015; 36(esp):192-9. doi:

Norhayati MN, Hazlina NHN, Sulaiman Z, Azman MY. Severe maternal morbidity and Near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study. BMC Public Health. 2016; 16:229. doi:

Rosendo TMSS, Roncalli AG. Prevalência e fatores associados ao Near miss materno: inquérito populacional em uma capital do Nordeste Brasileiro. Ciênc Saúde Coletiva. 2015; 20(4):1295-304. doi:

Monte AS, Teles LMR, Costa CC, Gomes LFS, Damasceno AKC. Analysis of the potentially life threatening conditions of women in intensive care units. Rev Rene. 2017; 18(4):461-7. doi:

Whittemore R, Knafl K. The integrative re-view: updated methodology. J Adv Nurs. 2005; 52(5):546-53. doi:

World Health Organization: Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: WHO; 2011

Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA group preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. doi:

Ursi ES, Gavão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Latino-am Enfermagem. 2006; 14(1):124-31. doi:

Cecatti JC, Souza, JP, Oliveira Neto AF, Parpinelli MA, Sousa MH, Say L, et al. Pre-validation of the WHO organ dysfunction based criteria for identification of maternal Near miss. Reprod Health. 2011; 8:22. doi:

Morse ML, Fonseca SC, Gottgtroy CL, Waldmann CS, Gueller E. Severe maternal morbidity and near misses in a regional reference hospital. Rev Bras Epidemiol. 2011; 14(2):310-22. doi:

Lotufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG. Applying the new concept of maternal near-miss in an intensive care unit. Clinics. 2012; 67(3):225-30. doi:

Lobato G, Nakamura-Pereira M, Mendes-Silva W, Dias MAB, Reichenheim ME. Comparing different diagnostic approaches to severe maternal mor-bidity and near-miss: a pilot study in a Brazilian tertiary hospital. Eur J Obstet Gynecol Reprod Biol. 2013; 167(1):24-8. doi:

Oliveira LC, Costa AR. Fetal and neonatal deaths among cases of maternal near miss. Rev Assoc Med Bras. 2013; 59(5): 487-94. doi:

Dias MAB, Domingues RMSM, Schilithz AOC, Nakamura-Pereira M, Diniz CSG, Brum IR, et al. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study. Cad Saúde Pública. 2014; 30(Suppl1):169-81. doi:

Galvão LPL, Alvim-Pereira F, Mendonça CMM, Menezes FEF, Góis KAM, Ribeiro Jr RF, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth. 2014; 14(25):1-8. doi:

Karolinski A, Mercer R, Micone P, Ocampo C, Mazzoni A, Fontana O, et al. The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina. BJOG. 2013; 120(13):1685-94. doi:

Van den Akker T, Beltman J, Leyten J, Mwagomba B, Meguid T, Stekelenburg J, et al. The WHO maternal near miss approach: consequences at Malawian district level. PLoS One. 2013; 8:e54805-10. doi:

Nelissen E, Mduma E, Broerse J, Ersdal H, Evjen-Olsen B, van Roosmalen J, et al. Applicability of the WHO maternal near miss criteria in a low-resource setting. PLoS One. 2013; 8:e61248-10. doi:

Litorp H, Kidanto HL, Rööst M, Abeidl M, Nyström LN, Essén B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014; 14:244. doi:

Jabir M, Abdul-Salam I, Suheil DM, Al-Hilli W, Abul-Hassan S, Al-Zuheiri A, et al. Maternal Near miss and quality of maternal health care in Baghdad, Iraq. BMC Pregnancy Childbirth. 2013; 13:11. doi:

Rana A, Baral G, Dangal G. Maternal Near-Miss: A multicenter surveillance in Kathmandu valley. J Nepal Med Assoc [Internet]. 2013 [cited 2017 Nov. 10]; 52(190):299-304. Available from:

Shen FR, Liu M, Zhang X, Yang W, Chen YG. Factors associated with maternal near-miss morbidity and mortality in Kowloon Hospital, Suzhou, China. Int J Gynecol Obstet. 2013; 123(1):64-7. doi:

Tunçalp O, Hindin MJ, Adu-Bonsaffoh K, Adanu RM. Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana. Int J Gynecol Obstet. 2013; 123(1):58-63. doi:

Luexay P, Malinee L, Pisake L, Bouvier-Colle MH. Maternal near-miss and mortality in Sayaboury Province, Lao PDR. BMC Public Health. 2014; 14:945. doi:

Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of obstetric Near miss and maternal deaths in a tertiary care hospital in North India: shifting focus from mortality to morbidity. J Obstet Gynaecol India. 2014; 64(6):394-9. doi:

David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C, et al. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy Childbirth. 2014; 14:401. doi:

Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML, et al. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014; 5;14:159. doi:

Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the “third delay”. PLoS One. 2013; 8:e63846. doi:

Organização Mundial da Saúde. Recomendações da OMS para a prevenção e tratamento da hemorragia pós-parto [Internet]. 2014 [citado 2017 11 out]. Disponível em:

Aguiar CA, Tanaka ACA. Memórias coletivas de mulheres que vivenciaram o near miss materno: necessidades de saúde e direitos humanos. Cad Saúde Pública. 2016; 32(9):e00161215. doi:



How to Cite

Monte, A. S., Mendes, I. C., Oriá, M. B. O., Carvalho, F. H. C., Brown, H., & Damasceno, A. K. de C. (2018). Near miss maternal: influencing factors and guidelines for reducing maternal morbidity and mortality. Rev Rene, 19, e3182.



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