Surveillance of severe maternal morbidity and maternal mortality in maternity hospitals of the Latin American and Caribbean network - Red CLAP: study protocol

ABSTRACT

The sustained reduction in maternal mortality in America underlines the need to analyse women who survived a complication that could have been fatal if appropriate and timely care had not been taken. Analysis of maternal near-miss (MNM) cases, as well as potentially life-threatening conditions (PLTC), are considered indicators for monitoring the quality of maternal care. The specific objective of this study protocol is to develop a surveillance system for PLTC, MNM and maternal mortality, as primary outcomes, in Latin American and Caribbean maternal healthcare institutions. Secondarily, the study was designed to identify factors associated with these conditions and estimate how often key evidence-based interventions were used for managing severe maternal morbidity. This is a multicenter cross-sectional study with prospective data collection. The target population consists of all women admitted to health centres participating in the network during pregnancy, childbirth, or the postpartum period. Variables describing the sequence of events that may result in a PLTC, MNM or maternal death are recorded. Relevant quality control is carried out to ensure the quality of the database and confidentiality. Centres with approximately 2,500 annual deliveries will be included to achieve a sufficient number of cases for calculation of indicators. The frequency of outcome measures for PLTC, MNM and maternal mortality and their confidence intervals and differences between groups will be calculated using the most appropriate statistical tests. Similar procedures will be performed with variables describing the use of evidence-based practices. Networking creates additional possibilities for global information management and interaction between different research groups. Lessons can be learned and shared, generating scientific knowledge to address relevant health problems throughout the region with provision of efficient data management.

KEYWORDS:

• Severe maternal morbidity
• potentially life-threatening conditions
• maternal near-miss
• maternal mortality
• Latin america

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

The authors acknowledge full PAHO-CLAP support for the development of this network and also professionals from all countries involved in the initiative.

Author contributions

All authors contributed equally to the original idea, manuscript writing, critical review, and final version approval.

Disclosure statement

The authors deny having any conflicts of interest. Authors who are staff members of the Pan American and World Health Organization, are responsible for their views expressed in this publication and do not necessarily represent the Pan American Health Organization decisions or policies.

Ethics approval and consent

The present protocol was submitted and approved by the PAHO Ethics Review Committee on August 2018 (PAHOERC Ref. No: PAHO-2018-04-0025). It also waived the need for an informed consent form for each participating woman.

Paper context

Current knowledge of maternal death alone is no longer sufficient to provide maternal health assessment. It is necessary to monitor the occurrence of several degrees of maternal complications that could lead to death if no appropriate and timely intervention is provided. This protocol describes a network created for surveillance of these complications in Latin American and Caribbean countries, to make changes in policies and improve maternal and perinatal health.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2249771.

Additional information

Funding

This manuscript was developed under financial support from CLP/WR - Latin American Center for Perinatology, Women’s and Reproductive Health of the Pan American Health Organization (PAHO), Montevideo, Uruguay. No grant number is available.