Main Article Content


This article reviews critical aspects that have had an impact on the implementation of epidemiological surveillance of Extreme Maternal Morbidity (MME, for its initials in Spanish), as a tracer event of quality maternal care at population and institutional level; taking into account that maternal mortality has been usually monitored, and its analysis allows interventions to avoid maternal death. Until 2015, very few countries had been able to meet the goals established in the Millennium Development Goals (MDGs), especially MDG 5 - improving maternal health. As of today, it is observed that maternal mortality rate is quite heterogeneous, with rates from 1 case per 100,000 live births in developed countries, to more than 100 cases per 100,000 live births in developing countries. Therefore, complementary strategies such as surveillance of the MME could offer a more effective alternative to identify and implement interventions that allow us to prevent mortality and strengthen the quality of obstetric care. In addition, the importance of MME as a quality tracer event is that, unlike what is observed with maternal mortality, this is an event that occurs more frequently, is anticipatory of death, and the surviving pregnant woman is the primary source of information.


Edgar Ivan Ortiz, 1 Universidad del Valle, Facultad de Salud, Departamento de Ginecología y Obstetricia, Cali, Colombia, 2 Presidente Federación Colombiana de Asociaciones de Obstetricia y Ginecología - FECOLSOG, Bogotá, Colombia, 3 Presidente Federación Latinoamericana de Obstetricia y Ginecología - FLASOG. Ciudad de Panamá, Panamá


Enrique Herrera, Universidad del Valle, Facultad de Salud, Departamento de Ginecología y Obstetricia, Cali, Colombia,


Alejandro De La Torre, Director Cientifico, Centro Médico Imbanaco, Cali, Colombia,


Lewis G. Beyond the Numbers: reviewing maternal deaths and disabilities to make pregnancy safer. In: Kehoe S, Neilson J, Norman J. Maternal and Infant Deaths: Chasing Millennium Development Goals 4 and 5 Cambridge: Cambridge University Press; 2010. pp. 49-60.

Ronsmans C. Severe acute maternal morbidity in low-income countries. Best Pract Res Clin Obstet Gynaecol. 2009; 23(3): 305-16.

Henao L. Caracterización de la morbilidad materna extrema en la Clínica Universitaria Colombia: una serie de casos. Rev Medica Sanitas. 2016; 19(2):66-77.

Federación Latinoamericana de Obstetricia y Ginecología (FLASOG). Comité de mortalidad materna. Santa Cruz de la Sierra, Bolivia; 2007. Available from:

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the un Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387(10017): 462-74.

Naciones Unidas. Objetivos de desarrollo del milenio. Objetivo 5: Igualdad de género. Programa de las Naciones Unidas para el Desarrollo PNUD; 2015. Available from:

Pinilla SME; Equipo funcional Maternidad Segura. Informe de evento mortalidad materna, Colombia, 2018. Instituto Nacional de Salud; 2019. Available from:

Naciones Unidas; CEPAL. La Agenda 2030 y los Objetivos de Desarrollo Sostenible: una oportunidad para América Latina y el Caribe. Objetivos, metas e indicadores mundiales. Naciones Unidas; 2019. Available from:

UNFPA Latinoamérica. América Latina y el Caribe tienen la segunda tasa más alta de embarazo adolescente en el mundo. Fondo de Población de las Naciones Unidas; 2018. p. 2. Available from:érica-latina-y-el-caribe-tienen-la-segunda-tasa-más-alta-de-embarazo-adolescente-en-el-mund-1.

Souza JP, Cecatti JG, Faundes A, Morais SS, Villar J, Carroli G, et al. Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health. Bull World Health Organ. 2010; 88(2): 113-9.

Pattinson RC, Buchmann E, Mantel G, Schoon M, Rees H. Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? BJOG. 2003;110(10):889-93.

Equipo Maternidad Segura, Subdirección de Prevención Vigilancia y Control en Salud Pública. Protocolo de Vigilancia en Salud Pública: morbilidad materna extrema. Instituto Nacional de Salud; 2014. Available from:

WHO. The WHO near-miss approach for maternal health. WHO; 2011. Pp 1-34. Available from:

Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: The prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004; 1: 1-5.

Tunçalp Ö, Souza JP. Maternal near-miss audits to improve quality of care. BJOG. 2014; 121(Suppl 4): 102-4.

Okong P, Byamugisha J, Mirembe F, Byaruhanga R, Bergstrom S. Audit of severe maternal morbidity in Uganda - Implications for quality of obstetric care. Acta Obstet Gynecol Scand. 2006;85(7):797-804.

Ortiz L, Quintero C, Mejía J, Romero E, Ospino L. Caracterización de la morbilidad materna extremadamente Grave (near miss) en instituciones seleccionadas de América Latina. FLASOG; 2010.

De Mucio B, Abalos E, Cuesta C, Carroli G, Serruya S, Giordano D, et al. Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America. Reprod Health. 2016;13(1):1-10.

UNFPA Dirección General de Salud Pública Ministerio de la Protección Social Fondo de Población de las Naciones Unidas. Vigilancia de la morbilidad materna extrema (MME). Bogotá D.C; cited: 2019 Mar 5; 2006. Available from:

Haddad SM, Cecatti JG, Souza JP, Sousa MH, Parpinelli MA, Costa ML, et al. Applying the maternal near miss approach for the evaluation of quality of obstetric care: A worked example from a multicenter surveillance study. Biomed Res Int. 2014; 2014: Article ID 989815.

Cherles V, Taylor S. Systems analysis of clinical incidents: The London Protocol. J Patient Risk Management. 2004; (10): 211-220.

Ortiz EI, Ludmir J. ¿Hacia dónde vamos en seguridad y calidad de la atención obstétrica en Colombia? Colomb Med (Cali). 2016;47(1):9-10.

Amaya J, Ariza K, Beltrán A, Ronderos M, Quevedo M, Matallana M, et al. Modelo de vigilancia de la morbilidad materna extrema Evaluación de la implementación. Ministerio de salud y Protección Social - Fondo de las Naciones

Unidas (UNFPA): Bogota D.C; 2014. Available from:ón-MVMME.pdf

Ministerio de Salud y Protección Social. Modelo de seguridad para la atención de la emergencia obstétrica. Bogotá: Ministerio de Salud y Protección Social; 2014; pp 122. Available from:

Ortiz, E. I., Herrera, E., & De La Torre, A. (2024). Extreme Maternal Morbidity: a tracer event to improve the quality of obstetric care in Latin America. Colombia Medica, 50(4), 286–92.


Download data is not yet available.
Received 2020-02-11
Accepted 2020-03-30
Published 2024-05-20