{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:34:23Z","timestamp":1786739663453,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n INTRODUCTION:<\/jats:title>\n Investigating severe maternal morbidity and near-miss cases are applied internationally as a new indicator to examine the quality of maternal care and as an effective strategy to reduce maternal mortality. This study aimed to determine the root causes of severe maternal morbidity in order to improve maternal health.<\/jats:p>\n <\/jats:sec>\n \n MATERIALS AND METHODS:<\/jats:title>\n The present research is a descriptive case series study. The data was obtained from the hospital and health records of mothers admitted to hospitals affiliated to Isfahan University of Medical Sciences due to severe morbidity in the first 6 months of 2018, which were selected randomly. The data collection was completed by interviews with the mentioned mothers and 14 related health-care staffs and that led to the development of the morbidity story. The compiled story of each case was evaluated by the root analysis team's opinion. Causes of morbidity were determined according to a root cause analysis checklist composing of factors such as health-care services (human and structural factors), family-social status, and disease status of maternal morbidity.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n The findings indicated that human factors related to the health system led to severe maternal morbidity more than any cause. Inadequate knowledge and skills of service providers, disregard for guidelines and protocols, lack of teamworking, and lack of considering competency were the most important human factors. Disease condition, family, and social status were the other related factors, respectively.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n Human factors are the most important cause of maternal morbidity based on the results of this study. Therefore, modifying the health structure can be one of the most important reducing factors for maternal mortality in order to improve the services for these individuals.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jehp.jehp_769_19","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T11:27:54Z","timestamp":1593689274000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Maternal health improvement through root cause analysis of severe maternal morbidity (maternal near miss) in Isfahan, Iran"],"prefix":"10.4103","volume":"9","author":[{"given":"Sepideh","family":"Zhali","sequence":"first","affiliation":[{"name":"Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnaz","family":"Kohan","sequence":"additional","affiliation":[{"name":"Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azar Danesh","family":"Shahraki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Beigi","sequence":"additional","affiliation":[{"name":"Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"key":"R1-20260528","doi-asserted-by":"crossref","first-page":"315","DOI":"10.4103\/1735-9066.157825","article-title":"Investigation of the causes of maternal mortality using root cause analysis in Isfahan, Iran in 2013-2014","volume":"20","author":"Beigi","year":"2015","journal-title":"Iran J Nurs Midwifery Res"},{"key":"R2-20260528","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s12978-018-0527-2","article-title":"A global view of severe maternal morbidity: Moving beyond maternal mortality","volume":"15","author":"Geller","year":"2018","journal-title":"Reprod Health"},{"key":"R4-20260528","first-page":"1","article-title":"Incidence and correlates of maternal near miss in southeast Iran","author":"Naderi","year":"2015","journal-title":"Int J Reprod Med 2015"},{"key":"R5-20260528","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4103\/ijph.IJPH_268_16","article-title":"\u201cNear-Miss\u201d obstetric events and maternal mortality in a tertiary care hospital","volume":"61","author":"Tallapureddy","year":"2017","journal-title":"Indian J Public Health"},{"key":"R6-20260528","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s12889-016-2895-2","article-title":"Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: A cross-sectional study","volume":"16","author":"Norhayati","year":"2016","journal-title":"BMC Public Health"},{"key":"R7-20260528","doi-asserted-by":"crossref","first-page":"177","DOI":"10.2147\/IJWH.S160022","article-title":"Severe maternal morbidity (near-miss) and its correlates in the world's newest nation: South Sudan","volume":"11","author":"Alemu","year":"2019","journal-title":"Int J Womens Health"},{"key":"R8-20260528","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13037-016-0107-8","article-title":"How to perform a root cause analysis for workup and future prevention of medical errors: A review","volume":"10","author":"Charles","year":"2016","journal-title":"Patient Saf Surg"},{"key":"R9-20260528","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1186\/1471-2393-14-231","article-title":"A root-cause analysis of maternal deaths in Botswana: Towards developing a culture of patient safety and quality improvement","volume":"14","author":"Madzimbamuto","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"R10-20260528","first-page":"1","article-title":"Root-cause analysis of persistently high maternal mortality in a rural district of Indonesia: Role of clinical care quality and health services organizational factors","author":"Mahmood","year":"2018","journal-title":"Biomed Res Int 2018"},{"key":"R11-20260528","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0213719","article-title":"Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria","volume":"14","author":"Okonofua","year":"2019","journal-title":"PLoS One"},{"key":"R12-20260528","doi-asserted-by":"crossref","first-page":"2976","DOI":"10.1111\/jocn.13638","article-title":"Chinese women health ambassadors programme: A process evaluation","volume":"26","author":"Wong","year":"2017","journal-title":"J Clin Nurs"},{"key":"R13-20260528","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.4103\/ATMPH.ATMPH_535_17","article-title":"Analysis of maternal mortality in Isfahan, Iran: A case series study","volume":"10","author":"Bahreini","year":"2017","journal-title":"Ann Trop Med Public Health"},{"issue":"Suppl 3","key":"R14-20260528","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1111\/1475-6773.12592","article-title":"Integrated approach to reduce perinatal adverse events: standardized processes, interdisciplinary teamwork training, and performance feedback","volume":"51","author":"Riley","year":"2016","journal-title":"Health Serv Res"},{"key":"R15-20260528","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1186\/s12884-018-2088-3","article-title":"Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian City: An exploratory qualitative approach on contextual issues","volume":"18","author":"Portela","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"R16-20260528","first-page":"265","article-title":"Reviewing the effectiveness of pre-pregnancy counseling protocol on pregnancy and labor indices","volume":"16","author":"Shahidi","year":"2011","journal-title":"Iran J Nurs Midwifery Res"},{"key":"R17-20260528","first-page":"934","article-title":"Maternal mortality due to eclampsia in Khyber Pakhtunkhwa: Identifying underlying risk factors, and care-seeking behaviours","volume":"69","author":"Mir","year":"2019","journal-title":"J Pak Med Assoc"},{"key":"R18-20260528","first-page":"1373","article-title":"Challenges to implementing physiologic birth program (PBP): A qualitative study of midwives opinion in Iran","volume":"31","author":"Janani","year":"2015","journal-title":"Acta Medica Mediterranea"}],"container-title":["Journal of Education and Health Promotion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jehp.jehp_769_19","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:30:56Z","timestamp":1786735856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jehp.jehp_769_19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":17,"URL":"https:\/\/doi.org\/10.4103\/jehp.jehp_769_19","relation":{},"ISSN":["2277-9531","2319-6440"],"issn-type":[{"value":"2277-9531","type":"print"},{"value":"2319-6440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"assertion":[{"value":"2019-12-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}