title: A systematic review of maternal near miss and mortality due to postpartum hemorrhage.
abstract: 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.
  
  
  OBJECTIVE
  To determine the near-miss ratio and maternal mortality index for PPH globally.
  
  
  METHODS
  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."
  
  
  METHODS
  Near-miss studies and audits describing the severe maternal outcome rate for PPH were included.
  
  
  METHODS
  Data were extracted from eligible publications. Quantitative analysis and narrative synthesis were used.
  
  
  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.
authors.affiliation: Wits Obstetrics and Gynaecology Clinical Research Division, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Salome
authors.initials: S
authors.lastname: Maswime
authors.affiliation: Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Eckhart
authors.initials: E
authors.lastname: Buchmann
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000401:mortality*; D011247:Pregnancy
keywords: Near miss; Obstetric hemorrhage; Postpartum hemorrhage; Severe acute maternal morbidity