{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:34:02Z","timestamp":1791635642454,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,3,23]],"date-time":"2016-03-23T00:00:00Z","timestamp":1458691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Faculty of Medicine, Uppsala University; Uppsala University Hospital, Sweden"},{"name":"Swedish Research Links program"},{"name":"Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cesarean section carries a substantial risk of maternal near\u2010miss morbidity. The aim of this study was to determine the frequency, causes, risk factors, and perinatal outcomes of maternal near\u2010miss at three university hospitals with a high rate of cesarean section in Tehran, Iran.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>An incident case\u2010control study was conducted from March 2012 to May 2014. The modified <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> near\u2010miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near\u2010miss ratio, crude and adjusted odds ratios with confidence intervals were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 12 965 live births, 82 mothers developed near\u2010miss morbidities and 12 died. The maternal near\u2010miss ratio was 6.3\/1000 live births. Severe postpartum hemorrhage (35%, 29\/82), severe preeclampsia (32%, 26\/82), and placenta previa\/abnormally invasive placenta (10%, 8\/82) were the most frequent causes of maternal near\u2010miss. Women with antepartum cesarean section (adjusted odds ratio 7.4, 95% confidence interval 3.7\u201315.1) and co\u2010morbidity (adjusted odds ratio 2.3, 95% confidence interval 1.4\u20133.8), uninsured Iranians (adjusted odds ratio 3.4, 95% confidence interval 1.7\u20137.1) and uninsured Afghans (adjusted odds ratio 4.7, 95% confidence interval 2.4\u20139.2) had increased risks of near\u2010miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with maternal near\u2010miss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overutilization of cesarean section clearly influenced the causes of maternal near\u2010miss. A lack of health insurance had a measurable impact on near\u2010miss morbidity. Tailored interventions for reducing unnecessary cesarean section and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.12881","type":"journal-article","created":{"date-parts":[[2016,2,26]],"date-time":"2016-02-26T09:54:32Z","timestamp":1456480472000},"page":"777-786","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Maternal near\u2010miss at university hospitals with cesarean overuse: an incident case\u2010control study"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3394-6444","authenticated-orcid":false,"given":"Soheila","family":"Mohammadi","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden"},{"name":"Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2900-2849","authenticated-orcid":false,"given":"Birgitta","family":"Ess\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Fallahian","sequence":"additional","affiliation":[{"name":"Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robabeh","family":"Taheripanah","sequence":"additional","affiliation":[{"name":"Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soraya","family":"Saleh Gargari","sequence":"additional","affiliation":[{"name":"Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-6528","authenticated-orcid":false,"given":"Carina","family":"K\u00e4llest\u00e5l","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"The World Bank.Millennium development goals. Improved maternal health by 2015. Available online at:http:\/\/www.worldbank.org\/mdgs\/maternal_health.html(accessed 30 May 2015)."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68704-7"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.519018"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.007"},{"key":"e_1_2_9_6_1","volume-title":"Evaluating the quality of care for severe pregnancy complications: the WHO near\u2010miss approach for maternal health","author":"World Health Organization","year":"2011"},{"key":"e_1_2_9_7_1","unstructured":"World Health Organization Global Health Observatory.Country profiles: Islamic Republic of Iran. 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