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A maternal near miss (MNM) is an event in which a pregnant woman comes close to maternal death, but does not die – a "near-miss". Traditionally, the analysis of maternal deaths has been the criteria of choice for evaluating women’s health and the quality of obstetric care. Due to the success of modern medicine such deaths have become very rare in developed countries, which has led to an increased interest in analyzing so-called "near miss" events. ==Background== Maternal mortality is a sentinel event to assess the quality of a health care system. The standard indicator is the Maternal Mortality Ratio, defined as the ratio of the number of maternal deaths per 100,000 live births. Due to improved health care the ratio has been declining steadily in developed countries. For example, in the UK 1952-1982 the ratio was halving every 10 years.〔Marsh 1998:176〕 In the European Union the ratio has now stabilized at around 10 to 20.〔Minkauskienė 2004:299〕 The small number of cases makes the evaluation of maternal mortality practically impossible〔〔See also the Poisson distribution for a discussion of statistical methodological difficulties when the number of cases is "small"〕 Historically, the study of negative outcomes have been highly successful in preventing their causes, this strategy of prevention therefore faces difficulties when if the number of negative outcome drop to low levels. In the UK, for example, the most dramatic decline in maternal death was achieved in Rochdale, an industrial town in the poorest area of England. In 1928 the town had a Maternal Mortality Ratio of over 900 per 100,000 live births, more than double the national average of the time. An enquiry into the causes of the deaths reduced the ratio to 280 per 100,000 pregnancies by 1934, only six years later, then the lowest in the country.〔Lewis 2003:31〕 The very low figures of maternal mortality have therefore stimulated an interest in investigating cases of life threatening obstetric morbidity or maternal near miss. There are several advantages of investigating near miss events over events with fatal outcome * near miss are more common than maternal deaths〔list is based on Adisasmita 2008 unless otherwise indicated〕 * their review is likely to yield useful information on the same pathways that lead to severe morbidity and death, * investigating the care received may be less threatening to providers because the woman survived * one can learn from the women themselves since they can be interviewed about the care they received. * all near misses should be interpreted as free lessons and opportunities to improve the quality of service provision〔Tingle 2002:3〕 * it is also clear that maternal deaths merely are the tip of the iceberg of maternal disability. For every woman who dies, many more will survive but often suffer from lifelong disabilities.〔Lewis 2003:29〕 The growing interest is reflected in an increasing number of systematic reviews on the prevalence of near miss.〔Adisasmita 2008〕〔Dott 2005〕 The studies and reviews span * analytic attempts to define the concept more strictly, * descriptive efforts to measure and quantify new indicators (prevalence) of near-miss for different geographical regions etc. * explanatory efforts of the leading cause for morbidity 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Maternal near miss」の詳細全文を読む スポンサード リンク
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