text:
Alternative Routes of Medication Administration for Symptom Management in End of Life Care for People with Dementia d. Rectal preparations Certain analgesics eg paracetamol and diclofenac can be administered rectally as suppositories (see section 2. Assessment). NB See comments re consent under 3.3 Constipation: rectal laxatives 2. Assessment – Including optimisation of current treatment … ... More
Short Fiction By Stephen King, 1967-2018 1967 The Glass Floor (short story) (collected in Night Shift) 1969 Night Surf (short story) (published in the Spring 1969 issue of Ubris) (collected in Night Shift) 1969 The Reaper's Image (short story) (published in the Spring 1969 issue of Startling Mystery Stories) (collected in Skeleton Crew) 1969 Stud City (short story) (published in the Fall ... More
HDFC Life ProGrowth Plus - Balanced Fund: Get the Latest NAV Value, Performance and Returns of HDFC Life ProGrowth Plus - Balanced Fund. HDFC Standard Life � ... More
So experiments are being undertaken to measure the reactions of a man through data. Now a days statistics is used in all the aspects of the life as well as universal activities. ... More
Parents need to know that The Last Star is the third and final installment in the 5th Wave sci-fi trilogy by bestselling author Rick Yancey. The series led to the 2016 … ... More
A fictional story about an adopted Elf named Buddy who was raised in the North Pole. Went to New York, ate spaghetti, worked in a shiny mail room and eventually saved Christmas. Went to New York, ate spaghetti, worked in a shiny mail room and eventually saved Christmas. ... More
Deck Two on Rhapsody of the Seas Please note that Printable Deck Plans may not reflect the most recent changes. OUTSIDE Family Ocean View Stateroom Two twin beds (can convert into queen-size), additional bunk beds in separate area, private bathroom, separate sitting area with sofa bed. (237 sq. ft.) Large Ocean View Stateroom Two twin beds (can convert into queen-size), sitting area with ... More
Dec 30, 2018 in Writer Extension Zotero LibreOffice Integration makes it possible to insert citations and bibliography entries into LibreOffice Writer documents in thousands of different bibliography styles. ... More
CMIS defines a domain model plus bindings that can be used by applications to manipulate content stored in a repository. CMIS provides a common data model covering typed files and folders with generic properties that can be set or read. ... More
J. R. Ward Black Dagger Brotherhood #11 LOVER AT LAST J.R.WARD AT LAST The king and queen of the vampires, and any children they may have. ghardian View PDF M ARTIN L UTHER K ING, J R. LEGACY A WARD N OMINATION F ORM ... More
9/06/2017�� TELUGUGEEKS FREE PDF BOOK #3 : RICH DAD POOR DAD #4(telugu) Financial self education, Taking RISK| Big ideas #12 If you RISK like MUSK ? Why you should Take RISK? How to learn financial self ... More
A description of 'best-practice' use of veterinary drugs and chemicals – storage, record keeping, off-label use, inventory control, disposal of unwanted drugs and the like. ... More
Focused on increasing the credibility of research and evaluation, the Fourth Edition of Donna M. Mertens?s comprehensive Research and Evaluation in Education and Psychology: Integrating Diversity with Quantitative, Qualitative, and Mixed Methods incorporates the viewpoints of various research paradigms into its descriptions of these methods. ... More
April 30, 2016 Building a high performance team Every business owner has the same problems no matter what the industry is � it�s either Time, Team or Money. ... More
play by Anton Chekhov This page was last edited on 24 November 2018, at 02:09. All structured data from the main, property and lexeme namespaces is available under the Creative Commons CC0 License; text in the other namespaces is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. ... More
Download EFY Projectss torrent from books category on Isohunt. Torrent hash: A31EA7AB6F5A5228BBBD863FB1491292452E2AF1 ... More
Download 171 free sheet music and scores:My Way Sinatra Frank, Sheet music, scores ... More
of the river basin as a unit of management became more widely established in the middle of the nineteenth century. It was the massive water resources infrastructure development that took place across the world between 1920 and 1970 that ushered in a phase of �water resources development planning�. At the core of these initiatives was the view that river basin planning is primarily a ... More
Now we recommend you to Download first result Ibn Arabi Alone With The Alone Henry Corbin MP3 which is uploaded by Satash8 of size 7.81 MB , duration … ... More
WonderHowTo Adobe Acrobat How To: Make PDFs smaller using Acrobat By MeGustaLasOlas; 12/15/07 1:36 PM. WonderHowTo. PDFs are the industry standard for document sharing. However, sometimes PDFs generated by non-Adobe apps can tend to be larger than they need to be. In this video you'll learn how to make your PDF files smaller even if they were not generated by an Adobe � ... More
Why Can't My Laptop Open Pdf Files By Mark Clayton Submitted On November 23, 2009 Not being able to open document on you laptop can be very frustrating and can take hours to sort out. ... More
7/02/2015 · That is what the liver flush does, unclogs your liv er and gallbladder. Having your liver completely free of stones is the key to radiant health and longevity. Many people have hundreds, if not thousands of gallstones clogging up this vital organ of detoxification. Gallstones in the liver have been found to be the root cause of many ailments and diseases including diabetes, heart disease ... More
Click and select or Drag and drop your JPG files to dark blue box. Once you add all of your JPEG files , simply press Convert. This will convert your JPG to PDF files. ... More
Descargue y lea el libro de 101 Players - 101 Facts: The New England Patriots Edition (English Edition) en formato PDF o Epub en teachergratitude.co.uk. Puede descargar cualquier libro como 101 Players - 101 Facts: The New England Patriots Edition (English Edition) y guardarlo en su dispositivo para leerlo en cualquier momento. ... More
This manual is intended for use in a DC electrical circuits course and is appropriate for two and four year electrical engineering technology curriculums. The manual contains sufficient exercises for a typical 15 week course using a two to three hour practicum period. The topics range from basic laboratory procedures and resistor identification through series-parallel circuits, mesh and nodal ... More
DOWNLOAD CORPORATE FINANCE STEPHEN ROSS 10TH EDITION corporate finance stephen ross pdf Stephen Ross is presently the Franco Modigliani Professor of Finance and Economics at the Sloan School of Management, Massachusetts Institute of Technology. Amazon.com: Solutions Manual to accompany Corporate Corporate finance is an area of finance that deals with sources of … ... More
Dr Leonard Coldwell com Welcome To the solutions Dr December 20th, 2018 - Bombshell study shows aspartame depletes neurotransmitters in the brain makes brains vulnerable to chemical damage ... More
While most experts agree that Big Data and AI technology will have an enormous impact on the travel experience for consumers in 2019, the use of Biometric technology at TSA check points at airports has also become a popular buzzword for the upcoming year. ... More
Below we will show you top 10 Doc to PDF converter to help you to change the file format easily. Part 1: Top 5 Free Doc to PDF Converter for Windows Part 2: Top 5 Free Doc to PDF Converter for Mac ... More
3/09/2015�� Guys please provide an ebook on computer system architecture. I need 3rd edition by Morris mano, I hope you will upload soon. ... More
Tamerlane and Other Poems is the first published work by American writer Edgar Allan Poe. The short collection of poems was first published in 1827. Today, it is believed only 12 of approximately 50 copies of the collection still exist. The poems were largely inspired by Lord Byron, including the long title poem "Tamerlane", which depicts a historical conqueror who laments the loss of his ... More
Instant download of a repair manual for the 2002-2004 Honda CRF450R four-stroke bike. I have manuals for other years in different listings. Covers complete tear down and rebuild, pictures and part diagrams, torque specs, maintenance, troubleshooting, etc. ... More
Chapter Notes: Is Matter Around us Pure - Class 9 Science Notes for is matter around us pure chapter of class 9 science. Dronstudy provides free comprehensive chapterwise class 9 Science notes with proper images & diagram. ... More
The Lion the Witch and the Wardrobe Pocket Edition An unabridged CD audiobook of The Lion the Witch and the Wardrobe book two in the classic fantasy series The ... More
The World Bank, the World Trade Organization, the World Health Organization—all of these powerful world institutions are exactly what they say they are. They are all components of the one-world government, the world government prophesied for the endtime 2,000 years ago. ... More
26/04/2012 · The Presence of the Past by Rupert Sheldrake, 9781594774614, available at Book Depository with free delivery worldwide. ... More
We suggest, therefore, that the principal role and scope of IT in construction should be the support of predictions of the anticipated performance of the design of a � ... More
license This license authorizes the marriage in New York State of the parties named above by any person authorized by New York State Domestic Relations Law 11 to perform marriage … ... More
This solution extends ConceptDraw PRO v.9 mechanical drawing software (or later) with samples of mechanical drawing symbols, templates and libraries of design elements, for help when drafting mechanical engineering drawings, or parts, assembly, pneumatic, Mechanical Engineering Drawing Basics Pdf ... More
Books Advanced Search Best Sellers Top New Releases Deals in Books School Books Textbooks Books Outlet Children's Books Calendars & Diaries Where Did I Come From? and over 2 million other books are available for Amazon Kindle . ... More
Create PDF from 300+ file types (with source application installed) Nitro for Enterprise vs Adobe ® Acrobat® DC Serving over 600,000 organizations worldwide for 10 years and counting. Acrobat DC Pro Acrobat DC Standard. Insert and edit text - font, size, color, etc. Edit images and pages Edit image properties - brightness, contrast, colors, etc. Insert and edit Bates Numbering/stamping ... More
Download elements-of-statistical-computing or read elements-of-statistical-computing online books in PDF, EPUB and Mobi Format. Click Download or Read Online button to get elements-of-statistical-computing book now. ... More
E. Defining/non-defining relative clauses Join these sentences by means of a relative pronoun. DON'T FORGET THE NECESSARY COMMAS. 1. Thousands of people have … ... More
This blockbuster setting features two classic canons cleverly brought together by Douglas Wagner, "Seek Ye First" by Karen Lafferty and Pachelbel's Kanon in D. The accompaniment can be keyboard, handbell choir or rhythm group or CD track. The choral setting … ... More
Download teach your baby to sign revised and updated 2nd edition an illustrated guide to simple sign language for babies PDF, ePub, Mobi Books teach your baby to sign revised and updated 2nd edition an illustrated guide to simple sign language for babies PDF, ePub, Mobi ... More
Tourism is the largest service industry in India with a contribution of 6.23% to the national GDP and 8.78% of the total employment in India. 2. Meaning of Hospitality : ... More
16/03/2011 · Hi! I've a PDF file and when I open it into Illustrator it says that I haven't font installed in my system. So, is there a way to convert the font into vector patch using Adobe reader X pro? ... More
Advanced Engineering Mathematics Greenberg Advanced engineering mathematics (2nd edition): michael , buy advanced engineering mathematics (2nd edition) on amazoncom free � ... More
COMO ES AULA INTERNACIONAL Las unidades didacticas presentan la siguiente estructura: 2. EXPLORAR Y REFLEXIONAR En el segundo bloque, los alumnos realizan un trabajo de observacion de la lengua a partir de nuevas muestras o de ... More
Acson chilled water system has no limitation in piping length unlike Direct Expansion Each heat exchanger in the chiller is brazed and tested refrigerant system. one can access and service pump head pressure is sufficient to pump another process to vacuum the system before it is all the components in the chiller. it saves the hustles of field charging display total of 19 type of faulty ... More
Biology Question Bank for Entrance Exams For AIPMT Main other Medical Entrance Exam Prepration, Question Bank for Biology Biodiversity and its Conservation is given below. ... More
Tags: Kaplan Lecture Notes 2018, Kaplan Lecture Notes 2018 Surgery, Pdf, usmle step 2 ck, USMLE Step 2 CK Kaplan Lecture Notes, USMLE Step 2 CK Kaplan Lecture Notes 2018 Surgery Leave a Reply Cancel reply ... More
Sax,,Songs,,-,,appPicker fadesore.cc.vg/oVs Jan,,22,,,2016,,,,Alto,,Sax,,-,,Ill,,Be,,There,,-,,The,,Jackson,,5,,-,,Sheet,,Music,,Chords,,Vocals,,,,How,,to,, ... More
Download The Genie in Your Genes: Epigenetic Medicine and the New Biology of Intention Full E-Book Published on Dec 9, 2015 Your genes respond to your thoughts, emotions and beliefs. ... More
Boeing Commercial Airplanes offers airplanes and services that deliver superior design, efficiency and value to customers around the world. ... More
Cover your eyes then go up to someone in truth or dare and ask them out (does not matter the gender) Okay there, there is a whole lot more but yeah this is just me brainstorming have fun, at your parties/sleepovers/having friends over :))))) ... More
2 Introduction He kupu whakataki The exemplars in this book should be considered in conjunction with the discussion in Book 16. Opportunities for children to be creative and imaginative through the arts are woven throughout Te ... More
A medical school dean described the first year as "trying to drink water from a fire hose." Remember: If you choose this path, you are choosing a life full of standardized tests and Continuing Education requirements . ... More
Sleigh Bells Temple Blocks Drum Set Triangle Slapstick Glockenspiel/ Xylophone Violin I Violin II Viola Violoncello Contrabass f Allegro h=120 f f f f f f f f f f f f f f f f Music by Leroy Anderson Arranged by Fedor Vrtacnik SLEIGH RIDE (4) (4) ... More
"Acrostic Poem Template for Spring Writing! #freebie From A Sunny Day in First Grade" Snowmen at Night. Kindergarten Writing Teaching Writing Teaching Ideas Snowmen At Night Winter Activities Literacy Activities Christmas Writing Thing 1 Ecole Art A writing activity perfectly paired with "Snowmen at Night". Using a snowman graphic organizer students will brainstorm 3 things their snowman may ... More
JPG To PDF has a portable version which let people convert JPG To PDF files anywhere. Full Specifications What's new in version 2.3.1 Version 2.3.1 fixed the decryption bug. Full Specifications What's new in version 2.3.1 Version 2.3.1 fixed the decryption bug. ... More
INDUSTRIAL ENGINES Iveco SpA PowerTrain Publication edited by Marketing - Adv.& Promotion Print L31022019 - 01/05 8060 SERIES. 1 GB Thank you for preferring Iveco Mo tors and may we compliment you on the choice you have made. Before carrying out any work on the engine, read through the pro-cedures set out in this manual carefully. If you follow these instructions yo ur engine will be ... More
Betty crocker's mincemeat bars (1961) jean-nine Somerset, United States almost 11 years ago My first cookbook was the first edition of Betty Crocker's New Picture Cookbook. ... More
Buy Reinforced and Prestressed Concrete from Dymocks online BookStore. Find latest reader reviews and much more at Dymocks Find latest reader reviews … ... More
A Poor Wise Man by Mary Roberts Rinehart Web-Books.Com A Poor Wise Man Chapter 1.. ... More
Aug. 24th, 2016 @ 07:26 pm RSMeans Assemblies Cost Data 2016 by RSMeans Engineering Staff PDF DOWNLOADS TORRENT ... More
Chettynad Curry Palace is an authentic Indian restaurant located at Upper Weld Road. The name "Chettynad" derived from the Chettinad originally from the region of Tamil Nadu state in South India. ... More
Advice for teachers (digital publication) Contains learning and teaching activities and assessment advice including performance descriptors. Faculty discussion resources ... More
Click Download or Read Online button to get the-visual-culture-reader-text-only-2nd-second-edition-by-n-mirzoeff book now. This site is like a library, Use search box … ... More
In addition, the author provides online JAVA applets that illustrate various pivot rules and variants of the simplex method, both for linear programming and for network flows. These C programs and JAVA tools can be found on the book's website. The website also includes new � ... More
llb part 1 Islamic jurisprudence notes Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. ... More
The contract agreement letter is meant to make between two parties for successfully implementing any contract. It can be anything from buying property to the distribution of something etc. The important point is that both parties should be clear about the terms and conditions incorporated in the agreement letter of a contract to avoid any confusion in due course of time. ... More
Alcoholics Anonymous is a national organization dedicated to assisting sufferers of alcohol abuse and addiction with overcoming the challenges faced during the rehabilitation process. ... More
Free online book �The Daemon, the Gnu, and the Penguin� by Peter H. Salus. In addition to covering a history of free and open source, The Daemon, the Gnu, and the Penguin explores how free and open software is changing the world. ... More
Health benefits of Red cabbage Red cabbage has 10 times more vitamin A and twice as much iron as green cabbage. Regular intake of red cabbage will help you to remain healthy and active. ... More
Beauty Fades, Dumb Is Forever By Judy Sheindlin Paperback The Golden Ghetto: The Psychology Of Affluence Learning By Accident: A Caregiver's True Story Of Fear, Family, And Hope ... More
View, Download or Print This online �The Snows Of Kilimanjaro� PDF FREE! This full-text book is an absolute classic, you will love reading the PDF version. This full-text book is an absolute classic, you will love reading the PDF version. ... More
Medical mnemonics have been used forever to help students memorize details that would otherwise have become confusing. You as a medical student probably have a few mnemonics of your own. Members of the student lounge have provided us with an ever growing list of the most popular and useful medical mnemonics! ... More
insecure in love how anxious attachment can make you feel Sat, 15 Dec 2018 03:05:00 GMT insecure in love how anxious pdf - The secure and dismissive attachment ... More
Murder on the Orient Express.PDF. Hercule Poirot, to prove his ability and solve the crime using the power of his brain. Like all great murder mysteries, Murder on the Orient Express keeps us ... More
iNTROducTiON ANZ Transactive Administrators are security device users that have the entitlements to manage users and Roles. A minimum of 3 Administrators are required by ANZ Transactive. ... More
BOOK DESCRIPTION: Nominated as one of America�s best-loved novels by PBS�s The Great American Read. The #1 New York Times Bestseller. On a warm summer morning in North Carthage, Missouri, it is Nick and Amy Dunne�s fifth wedding anniversary. ... More
Gce O Level Examination Past Papers With Answer Guides (Largest Collection Of Exam Materials) Get latest Cambridge O Level, IGCSE, AS & A Level Past Papers, Marking Schemes, Specimen Papers, Examiner Reports and Grade Thresholds. ... More
Dell OptiPlex 9020 Small Form Factor Owner's Manual Regulatory Model: D07S Regulatory Type: D07S001 . Notes, cautions, and warnings NOTE: A NOTE indicates important information that helps you make better use of your computer. CAUTION: A CAUTION indicates either potential damage to hardware or loss of data and tells you how to avoid the problem. WARNING: A WARNING indicates a potential … ... More
Whether you have years of experience as a teacher or are new to the classroom, you and your students can count on The St. Martin�s Guide to Writing to provide the support you need in first-year composition, with a rhetoric, an array of engaging readings, a research manual, and a handbook, all in a single book � and available online. ... More
West Side Story, along with the four main characters from the show. The time period is meant to The time period is meant to be unspecified, but in terms of the … ... More
This PDF contains the question papers and solutions for the Intermediate Mathematical Challenge from 2012 to 2016 inclusive. The download is available once payment has been processed. ... More
large chicken coop Free Download Video PDF eBook The best ways to Pick a Woodworking Saw Sometimes the very first and crucial power tool individuals purchase for their workshop is the table saw. Normally, voltages for saws can be found in 120 or 240. ... More
The foundation of the Mike Dillard Magnetic Sponsoring course is you providing a TON of value to people so that you become the leader and people are attracted to you (attraction marketing) versus you seeking them out . ... More
7/12/2017 · A childhood fave....I spy with my lil eye ***More info and Social Media accounts Below*** Why hello my fellow MOON MATES! I hope I bring you Peace and Sarait... I … ... More
Title: Kevin Dutton The Wisdom Of Psychopaths Pdf 28, Author: rsenodcasfarm, Name: Kevin Dutton The Wisdom Of Psychopaths Pdf 28, Length: 3 pages, Page: 1, Published: 2018-12-09 kevin dutton … ... More
18/05/2018 · I have a current Adobe Export PDF subscription and was able to convert pdf to word without too many problems until a recent update from Reader to Reader DC. ... More
PDF Unlock accepts files up to 10MB in size. 2. Click the "Unlock!" button to remove print restrictions from your file. The file appears on your screen once the process has finished. 3. Select ... More
6-8 Months Before the Wedding Find your stationery: As a general rule, you�ll want to send out the �save the date� about four months before the wedding. If you�re having a destination wedding , plan to send these out at least eight months in advance. ... More
Ibm Cognos Report Studio User Guide 10 2 10.1.1 New features in version 10.1.1. 2. Report Name Used for the Exported Output File Name. Open a Report in IBM Cognos Report Studio. ... More
The health system that exists in Australia today is the result of years of accumulated knowledge. There are a range of models of health care in Australia today; the most significant are the biomedical and social models. Understanding the nature and role of each approach to health is important when assessing the adequacy and effectiveness of Australia's health system. The biomedical model of ... More
Blurb. A Discworld novel of dwarfs, diplomacy, intrigue and big lumps of fat. Sam Vimes is a man on the run. Yesterday he was a duke, a chief of police and the ambassador to the mysterious, fat-rich country of Überwald.
� A grammar can then be thought of as a set of phrase structure rules (categorial rules plus lexical rules). The categorial rules can be thought of as (part of) the syntax and the lexical rules �
Eight madcap tales of unpredictable dragons including one made of ice, another that takes refuge in the General Post Office, and a fire-breathing monster that flies out of an enchanted book …
Marine Biology covers the basics of marine biology with a global approach, using examples from numerous regions and ecosystems worldwide. This introductory, one-semester text is designed for non-majors. Authors Castro and Huber have made a special effort
In the Viennese transplant to America anticipated some reflections on spontaneous architecture that would find fulfillment years later with the publication of Architecture without architects. Delhi: The "architectural astronomical instruments" of Jantar Mantar built in the 18th century.
in Australia (for the cost of a local call) or contact the nearest Australian mission. Using a migration agent You do not need to use a migration agent to lodge a visa application.
Australian Capital Territory: Downer ACT, Watson ACT, Macgregor ACT, Kenny ACT, Yass ACT, ACT Australia 2631
New South Wales: Wilbetree NSW, Jerrabomberra NSW, Narraburra NSW, Allynbrook NSW, North Parramatta NSW, NSW Australia 2068
Northern Territory: Peppimenarti NT, Berry Springs NT, Charlotte Waters NT, Millner NT, Gray NT, Kaltukatjara NT, NT Australia 0825
Queensland: Lower Tully QLD, Cunnamulla QLD, Sunnybank Hills QLD, Geham QLD, QLD Australia 4043
South Australia: Tailem Bend SA, Evandale SA, Bumbunga SA, Vista SA, Weetulta SA, Hilton SA, SA Australia 5081
Tasmania: Abercrombie TAS, Wilmot TAS, Ambleside TAS, TAS Australia 7012
Victoria: Apsley VIC, Burramine South VIC, Garibaldi VIC, North Wonthaggi VIC, Highton VIC, VIC Australia 3005
Western Australia: Nangeenan WA, Cottesloe WA, Mulwarrie WA, WA Australia 6077
British Columbia: Prince George BC, Chilliwack BC, Armstrong BC, Smithers BC, Colwood BC, BC Canada, V8W 2W6
Yukon: Frances Lake YT, Carmacks YT, Readford YT, Scroggie Creek YT, Bear Creek YT, YT Canada, Y1A 9C7
Alberta: Paradise Valley AB, Vilna AB, Alix AB, Trochu AB, Calgary AB, Fort Macleod AB, AB Canada, T5K 4J3
Northwest Territories: Ulukhaktok NT, Gameti NT, Lutselk'e NT, Tulita NT, NT Canada, X1A 5L8
Saskatchewan: Ponteix SK, Naicam SK, Neville SK, Webb SK, Langenburg SK, Muenster SK, SK Canada, S4P 4C1
Manitoba: Winnipegosis MB, Morden MB, Leaf Rapids MB, MB Canada, R3B 1P6
Quebec: Metabetchouan–Lac-a-la-Croix QC, Saint-Ours QC, Ville-Marie QC, Bromont QC, Sainte-Anne-des-Monts QC, QC Canada, H2Y 5W4
New Brunswick: Saint-Leolin NB, Bouctouche NB, Saint-Hilaire NB, NB Canada, E3B 9H2
Nova Scotia: Liverpool NS, Port Hawkesbury NS, West Hants NS, NS Canada, B3J 7S6
Prince Edward Island: Warren Grove PE, Cavendish and North Rustico PE, Cavendish and North Rustico PE, PE Canada, C1A 3N1
Newfoundland and Labrador: Gillams NL, Fortune NL, Bauline NL, Admirals Beach NL, NL Canada, A1B 6J7
Ontario: Brant ON, Yule ON, Waldemar ON, Shannon Hall, Abingdon ON, Narva ON, Halpenny ON, ON Canada, M7A 4L6
Nunavut: Tree River NU, Baker Lake NU, NU Canada, X0A 7H5
England: Lancaster ENG, Blackburn ENG, Grimsby ENG, Liverpool ENG, Ewell ENG, ENG United Kingdom W1U 7A1
Northern Ireland: Derry�(Londonderry) NIR, Belfast NIR, Belfast NIR, Belfast NIR, Derry�(Londonderry) NIR, NIR United Kingdom BT2 2H6
Scotland: Livingston SCO, Dundee SCO, Aberdeen SCO, Aberdeen SCO, Glasgow SCO, SCO United Kingdom EH10 7B3
Wales: Neath WAL, Swansea WAL, Barry WAL, Wrexham WAL, Newport WAL, WAL United Kingdom CF24 9D9


text:
Price of 2018 WAEC GCE Scratch Cards and Selling Points
Price of WAEC GCE Form i.e. the card that would be used for registration and selling points. How Much Is WAEC GCE Form? Where Can I Purchase WAEC GCE Form or Scratch Card? Find The Answers Below.
Price of WAEC GCE Form (now refereed to as West African Senior School Certificate Examination (WASSCE) for Private Candidates). The First Series will be conducted between January and February, while the Second Series will be conducted between August and October every year.
Since the announcement of the commencement of the 2018/2019 West African Senior School Certificate Examination (WASSCE) for Private Candidates Registration, we have been receiving mails from different candidates regarding the price of the WAEC GCE scratch card/PIN and locations where the scratch cards are sold.
Helpful Links: 2018 WAEC GCE Nov/Dec Registration – Instructions & Guidelines
From the information reaching us, the 2017/2018 WAEC GCE Registration scratch card/PIN goes for 13,950 NGN (The PIN is used for registration during normal entry period before the start of the late registration period). WAEC GCE registration PIN and the information VCD are available at branches of any of the following banks or any accredited agent.
- Access Bank Plc
- Diamond Bank Plc
- Ecobank Ltd
- Fidelity Bank Plc
- Wema Bank Plc
- First Bank of Nig. Ltd.
- First City Monument Bank Plc
- Guaranty Trust Bank Plc
- Heritage Bank Plc
- Sterling Bank Plc
- Skye Bank Plc
- StanbicIBTC Bank Plc
- Standard Chartered Bank Plc
- Zenith Bank Plc
- Union Bank of Nigeria Plc
- United Bank for Africa Plc
- Unity Bank Plc
The registration card also contains the result checker. Keep the card after use for registration.
Copyright Warning: Contents on this website may not be republished, reproduced, redistributed either in whole or in part without due permission or acknowledgement. All contents are protected by DMCA.
The content on this site is posted with good intentions. If you own this content & believe your copyright was violated or infringed, make sure you contact us via This Means to file a complaint & actions will be taken immediately.
Related Posts:
Tags: WAEC GCE Registration Portal | registration.waecdirect.org, WAEC GCE Scratch Cards and Selling Points, West African Examinations Council | waecdirect.org

subset: commoncrawl


text:
- Review
- Open Access
A global view of severe maternal morbidity: moving beyond maternal mortality
© The Author(s). 2018
- Published: 22 June 2018
Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).
Severe maternal morbidity in high-income countries
Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify "high risk" status, delays in diagnosis, and delays in treatment.
Severe maternal morbidity in low and middle income countries
The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity.
Effects of SMM on delivery outcomes and infants
Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn.
Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women's and infants' health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.
Maternal mortality is a sentinel event used globally to monitor maternal health, the general quality of reproductive health care, and the progress countries have made toward international development goals [1, 2]. Globally, the maternal mortality ratio (MMR) dropped from 385 maternal deaths per 100,000 live births in 1990 to 216 in 2015, a 44% reduction [3]. Most high income countries (HICs) have low maternal death rates, generally ranging from 3 to 12 per 100,000, that have consistently decreased in the last 25 years [4]. The United States is an exception with an MMR of 14 per 100,000, a 16.7% increase since 1990 [4]. Low and middle incomes countries (LMICs) still bear 99% of the burden of maternal mortality and the majority of deaths occur in sub-Saharan Africa [3] A Sustainable Development Goal for 2030 is to reduce the global MMR to 70 per 100,000 births and for no country to exceed two times that ratio (140 per 100,000).
Globally, more than half of maternal deaths between 2003 and 2009 were due to hemorrhage, hypertensive disorders, and sepsis [5]. Common causes of maternal mortality varied by region: in Northern Africa, 36.9% of deaths were due to hemorrhage compared with 16.3% in HICs [5]. Deaths due to hypertensive disorders were most common in Latin America and the Caribbean, accounting for 22.1% of deaths [5]. The vast majority of deaths due to sepsis were in LMICs [5].
Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications [6, 7]. It is estimated that 50–100 women experience severe morbidity (SMM) compared to every maternal death in the United States and the rate has more than doubled from 74 per 10,000 delivery hospitalizations in 1998–99 to 163 in 2010–11 [2, 7]. Consistent with rates of maternal mortality, SMM rates are higher in LMICs than in HICs, complicating up to 8% of deliveries that take place in hospitals [8, 9]. These alarming rates and their implications for poor maternal and infant outcomes with long term poor health consequences, highlight a critical need for surveillance with the goal of understanding how to prevent SMM through quality improvement initiatives.
Maternal pregnancy outcomes can be conceptualized on a continuum of severity: normal/healthy pregnancy - > morbidity - > severe morbidity - > death [10]. Women with severe maternal morbidity experience severe pregnancy, delivery, and postpartum complications such as massive hemorrhage, cardiac arrest, organ system failure, stroke, and other health problems that may result in extended hospital stay, massive transfusion, hysterectomy, major surgery, or other major medical interventions [11]. The study of SMM provides opportunities to see a fuller picture of the quality of maternity care, potentially identifying factors associated with preventing the progression along the continuum to severe morbidity or death [2, 12]. As SMM emerges as an important area of increased interest globally, it is clear that the issues and solutions in LMICs are very different from those in HICs. This review presents current literature on SMM globally, first in HICs and then in LMICs.
Severe maternal morbidity in high-income countries
Estimates of the Prevalence of Severe Maternal Morbidity in High-Income Countries
Author (Year)
Definition of SMM
Estimated Prevalencea
Leading Causes
Bouvier-Colle (2012) [13]
17 EU Countries
3 EU Countries
ICU Admission
10 EU Countries
Blood Transfusion
15 EU Countries
7 EU Countries
Colmorn (2015) [71]
Denmark, Finland, Iceland, Norway, and Sweden
Complete uterine rupture
Deneux-Tharaux (2017) [16]
Obstetric hemorrhage, hypertensive complications,
Psychiatric disorder, decompensation of preexisting condition, pulmonary embolism, sepsis, stroke, amniotic fluid embolism, other
Obstetric hemorrhage (65.2%), hypertensive conditions (21.6%)
Jayaratnam (2016) [45]
WHO criteria
Jayaratnam (2011) [72]
Antepartum hemorrhage requiring emergency surgery, PPH requiring surgery, any postnatal patient requiring surgery, severe pre-eclampsia/eclampsia/HELLP,
ICU admission, shock, acute ruptured ectopic, pulmonary embolism, other conditions requiring immediate medical assessment
Kilpatrick (2016) [43]
United States
CDC method with chart review to confirm condition was truly life-threatening
Hemorrhage, hypertensive disorders
Lawton (2016) [personal communication]
New Zealand
ICU/HDU admission
Major blood loss, pre-eclampsia, sepsis
Lyndon (2012) [73]
United States
CDC method supplemented with birth certificate data
Main (2016) [74]
United States
"Gold standard" clinical guidelines
Marr (2014) [40]
Major obstetric hemorrhage, eclampsia, renal or liver dysfunction, pulmonary edema, acute respiratory distress, coma, cerebrovascular event, status epilepticus, anaphylactic shock, septicemic shock, anesthetic problem, massive pulmonary embolism, ICU/coronary care unit admission
Major obstetric hemorrhage, ICU/coronary care admission
Nair (2016) [20]
Acute abdomen
Acute renal failure
Acute psychosis
Cardiac arrest/failure or infarction
Cerebral edema or coma
Cerebrovascular accident
Major complications of anesthesia
Obstetric embolism (inc. AFE)
Sickle cell crisis
Status asthmaticus
Status epilepticus
Uterine rupture
Cerebral venous thrombosis
Assisted ventilation including tracheostomy
Curettage with general anesthesia
Evacuation of hematoma
Procedures to reduce blood flow to uterus
Re-closure of disrupted cesarean section wound
Repair of bladder or cystostomy
Repair of intestine
O'Malley (2016) [75]
WHO criteria
Scottish Audit of SMM criteria
Ozimek (2016) [37]
United States
"Gold standard" clinical guidelines from Main (2016)
Hemorrhage, preeclampsia/eclampsia
Zanconato (2012) [44]
ICU admission, transfusion ≥4 units, emergency peripartum hysterectomy, arterial embolization
Hypertensive disorders, hemorrhage, sepsis
Zwart (2010) [76]
The Netherlands
ICU admission, eclampsia/HELLP syndrome, uterine rupture, major hemorrhage, miscellaneous
7.1 overall
6.3 Western ethn
8.4 non-Western ethn
Peripartum hysterectomy
Abnormally invasive placenta
Severe hemorrhage at delivery
More recently, the EPIMOMS study group in France proposed a comprehensive set of 17 indicators specifically for use in HICs [16]. Their definition includes the EURO-PERISTAT indicators as well as measures of organ system dysfunction defined by minimal management-based criteria [16]. Both the EURO-PERISTAT and EPIMOMS definitions are based on data from existing sources such as hospital administrative records and laboratory tests. Similarly, in the United States, the CDC has published a list of 18 indicators and corresponding ICD codes using the 10th revision of the International Classification of Disease (ICD-10) to facilitate the identification of SMM using hospital discharge data [17, 18].
To move beyond a list of indicators and to define a composite indicator that could easily identify SMM from routinely collected population health data, researchers in Australia began with a list of 86 diagnoses and procedures that could potentially be included in the final composite [19]. To refine the components of the indicator, a validation study was conducted to assess whether cases that screened positive for SMM were true cases based on medical record review. The final SMM indicator comprised 14 diagnoses and 11 procedures with a positive predictive value of 94.6%, sensitivity of 78.4%, and specificity of 99.9% for confirmed SMM as identified by medical record review, the gold standard definition [19]. This indicator was adapted for use in England, taking into account limitations of the quality and reliability of English hospital data [20].
Departing from efforts to define SMM using information available in routinely collected administrative data, representatives from the 13 HICs in the International Network of Obstetric Surveillance Systems (INOSS) developed consensus definitions for eight severe morbidity conditions: eclampsia, amniotic fluid embolism, pregnancy-related hysterectomy, severe primary postpartum hemorrhage, uterine rupture, abnormally invasive placentation, spontaneous hemoperitoneum in pregnancy, and cardiac arrest in pregnancy [21]. Multidisciplinary panels used an iterative process to produce standardized definitions to promote comparability across countries. Clinical data is required to apply these definitions, necessitating additional data collection systems for their use [21].
Case review has long been the gold standard for assessing maternal deaths for the underlying cause of death, the factors that contributed to the progression from morbidity to death, and to determine whether the death was potentially preventable [22–25]. Reviews for potential preventability have provided valuable insights into opportunities to improve obstetrical care and management and identify themes and trends in preventability factors and translate these findings into action [26–30]. As attention in HICs moves to SMM, there have been initiatives to institute SMM case review as well [15, 24, 31]. For the purposes of case assessment, preventability can be defined as "any action or inaction on the part of the health care provider, system, patient, or a combination of these factors that may have caused progression to more severe morbidity" [32]. In other words, did the woman have to get as sick as she did? In addition to identifying factors that contributed to the progression to severe morbidity, SMM reviews may assist facilities in recognizing evidence-based practices that prevent maternal death, as women with SMM may survive because of medical intervention and best clinical practice.
The US Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) have called for greater monitoring and review of severe pregnancy and delivery complications, and also provided detailed recommendations for doing so [11, 15, 31]. The CDC and ACOG specifically recommend facility-level multidisciplinary review of all cases by using a two-factor scoring system that identifies SMM cases by: (1) admission to the intensive care unit (ICU) and/or (2) transfusion of four or more units of blood products at any time from conception through 42 days postpartum [33–35]. This 2-factor scoring system developed by Geller et al. has been validated and can be used in real time in hospital settings, unlike administrative datasets used for population-level surveillance [33, 34, 36]. To date, SMM reviews have been implemented in individual facilities in California [37] and Illinois recently piloted a statewide implementation through its regionalized perinatal system [38].
New Zealand adapted the Illinois model for their research and, with support from the New Zealand Ministry of Health, implemented multidisciplinary regional panels across the country to review cases of all women admitted to an ICU or high-dependency unit who were pregnant or within 42 days of delivery. The national rate of women with SMM admitted to an ICU/HDU was 6.2 per 1000 live births. Of those 399 cases reviewed, 34% were deemed potentially preventable, 29.5% were classified as not preventable but improvement in care was needed. Factors associated with preventable SMM cases, were provider (clinician) related in almost all cases (93.4%), most often issues related to diagnosis (inappropriate or delay in diagnosis or failure to recognize "high risk" patient) and/or treatment (inappropriate, delay or failure to treat). Major blood loss, pre-eclampsia and sepsis were the commonest clinical conditions where the severity of morbidity was deemed potentially preventable [14].
The UK implemented national reviews of SMM cases by adding it to their longstanding Confidential Enquiry into Maternal Deaths program [39]. Nominated reporting clinicians complete a monthly survey that is entered into a dedicated data collection system. The project does not provide population-level surveillance for a standardized definition of SMM; instead, it focuses on a changing set of severe morbidity/near miss conditions such as uterine rupture, eclampsia and pulmonary embolism to answer specific clinical questions [39]. Anonymous cases are reviewed by multidisciplinary experts to identify public health, hospital, and system problems that can inform future improvements in care [39].
Similarly, the Scottish Confidential Audit of Severe Maternal Morbidity (SCASMM) implemented a national 10 year surveillance project from 2003 to 2012 [40, 41]. All cases meeting one or more of the 14 SMM definitions were reported to the SCASMM during that time; cases of major obstetric hemorrhage (MOH) and eclampsia were reviewed in detail. Over the course of the project, the proportion of women with MOH who received appropriate care rose from 60% in 2004 to 80% in 2011 [41]. They found that the outcome could have been more favorable in just 4 to 10% of hemorrhage cases. Among 108 eclampsia cases that were assessed during the project period, 7 (6.5%) were deemed to have received suboptimal care [41].
The Netherlands also introduced SMM case reviews (67 cases) between 2005 and 2008 [42]. Cases were defined by ICU admission, uterine rupture, eclampsia/HELLP syndrome, massive obstetric hemorrhage, and cases referred to the panel by the treating obstetrician despite not being any of the specific criteria. Panel members were multidisciplinary and included members of the national maternal mortality review committee and clinicians of all obstetric disciplines. Substandard care and other potentially preventable factors were identified in 53 (74.6%) cases. The majority of factors identified (76.3%) were provider-related, 17.7% were health care system-related, and 6.0% were patient-related. The most common preventable factors were delays in diagnosis and treatment.
Since the WHO recommended that HICs with low maternal mortality ratios should begin to examine SMM to identify systems failures and intervention priorities [9], researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders [13, 16, 37, 43–45]. Fewer countries have undertaken review of SMM to identify preventable factors and opportunities for improvements in maternity care provided by hospitals and health systems. Of those that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify that the woman was progressing in severity, delays in diagnosis, and delays in treatment [14, 42, 46, 47].
Severe maternal morbidity in low and middle income countries
Estimates of the Prevalence of Severe Maternal Morbidity in Sub-Saharan Africa
Definition of SMM
Estimated Prevalencea
Leading Causes
Adeoye 2013 [66]
1 tertiary referral hospital, Ile-Ife
Filippi et al. 2005
Hemorrhage, hypertensive disorders, dystocia
Ali 2011 [77]
1 tertiary referral hospital, Kalassa
Filippi et al. 2005
Hemorrhage, infection, hypertensive disorders
David 2014 [78]
5 health facilities, Maputo city/province
eclampsia, infection hypertension, anemia, dystocia
Hemorrhage, hypertensive disorders, infection
Gebrehiwot 2014 [59]
10 public hospitals
hypertensive disorders, obstetric hemorrhage, dystocia, infection, anemia
Dystocia or uterine rupture, hypertensive disorders, hemorrhage
Goldenberg 2017 [51]
Democratic Republic of Congo
14 health centers and 3 hospitals, Equateur province
Modified WHO
Not reported by country
Goldenberg 2017
23 health facilities and 3 referral hospitals, Busia, Bungoma and Kakamega counties
Modified WHO
Not reported by country
Goldenberg 2017
8 health posts, 3 district hospitals and 1 referral hospital, Kafue and Chongwe districts
Modified WHO
Not reported by country
Herklots 2017 [79]
Tertiary referral hospital, Zanzibar
Hemorrhage, hypertensive disorders
Kalisa 2016 [80]
Provincial referral hospital, Musanze district
Modified WHO
Hemorrhage, hypertensive disorders
Kiruja 2017 [81]
Main referral hospital
Hemorrhage, hypertensive disorders, infection
Litorp 2014 [82]
2 hospitals, Dar es Salaam
Hypertensive disorders, hemorrhage
Liyew 2017 [83]
5 public hospitals, Addis Ababa
Hypertensive disorders, hemorrhage, abortive outcome
Lori 2012 [62]
Rural county
Modified WHO and Filippi et al. 2005
16% of deliveries
Hemorrhage, anemia, sepsis
Mbachu 2017 [54]
Private hospital, Elele
Hemorrhage, abortive outcome, hypertensive disorders
Mekango 2017 [84]
6 public hospitals, Tigray
Filippi et al. 2005
Hemorrhage, hypertensive disorders, dystocia
Nakimuli 2016 [85]
2 referral hospitals, Central Uganda
Hypertensive disorders, hemorrhage
Nelissen 2013 [86]
Referral hospital, rural
Modified WHO
Hemorrhage, abortive outcome, dystocia
Oladapo 2016 [57]
42 public tertiary hospitals
Hemorrhage, hypertensive disorders, abortive outcome
Rulisa 2015 [87]
University hospital, Kigali
Sepsis, hypertensive disorders, hemorrhage
Sayinzoga 2017 [88]
4 rural district hospitals
Modified WHO
Hemorrhage, uterine rupture, abortive outcome
Soma-Pillay 2015 [89]
South Africa
9 delivery facilities, Gauteng province
Hemorrhage, hypertensive disorders, sepsis
Tuncalp 2013 [90]
Tertiary referral hospital, Accra
Not reported
Estimates of the Prevalence of Severe Maternal Morbidity in North Africa and Middle East
Definition of SMM
Estimated Prevalencea
Leading Causes
Akrawi 2017 [91]
Public tertiary hospital, Erbil City
Modified WHO
Hypertensive disorders, hemorrhage
Assarag 2015 [92]
3 public referral hospital, Marrakech
Sahel et al. 2011
Bashour 2015 [93]
Public tertiary hospital, Cairo
Bashour 2015
Public hospital, Beirut
Bashour 2015
Public referral hospital, Ramallah
Bashour 2015
University hospital, Damascus
Ghardallou 2016 [94]
Public tertiary hospital, Sousse
Hemorrhage, hypertensive disorders
Ghazivakili 2016 [95]
13 public and private hospital, Alborz province
Hypertensive disorders, hemorrhage
Jabir 2013 [63]
6 public hospital, Baghdad
Hemorrhage, hypertensive disorders
Estimates of the Prevalence of Severe Maternal Morbidity in Asia
Definition of SMM
Estimated Prevalencea
Leading Causes
Bolnga 2017 [96]
Papua New Guinea
Provincial hospital, Madang Province
Modified WHO
Goldenberg 2017 [51]
18 primary health centers, 3 tertiary hospitals and 8 secondary hospitals Belagavi
Modified WHO
Not reported by country
Goldenberg 2017
20 primary health centers, 10 tertiary hospitals and 129 secondary hospitals, Nagpur
Modified WHO
Not reported by country
Goldenberg 2017
47 primary health clinics, 25 secondary care facilities and 3 referral hospitals, Thatta district
Modified WHO
Not reported by country
Kalra 2014 [97]
Tertiary hospital, Rajasthan
Geller et al. 2004
Hemorrhage, hypertensive disorders
Khan 2017 [98]
Tertiary referral hospital, New Delhi
Geller et al. 2004, Pattinson et al. 2003, ICD-10
Hemorrhage, hypertensive disorders, anemia
Luexay 2014 [99]
Community survey, Sayaboury province
Hemorrhage, hypertensive disorders
Mazhar 2015 [100]
16 government hospitals
Hemorrhage, hypertensive disorders, uterine rupture
Norhayati 2016 [101]
2 tertiary hospitals, Kelantan
Hemorrhage, hypertensive disorders
Roopa 2013 [102]
Tertiary referral hospital, Manipal
Hemorrhage, hypertensive disorders, sepsis
Pandey 2014 [55]
Medical college hospital, Uttar Predesh
Hemorrhage, hypertensive disorders, anemia
Purandare 2014 [60]
6 medical college hospitals
Pregnancy-specific disorders.
Pre-existing disorders aggravated during pregnancy, Pregnancy-specific medical disorders, Incidental and accidental causes that occurred in pregnancy
Rana 2013 [103]
9 tertiary hospitals, Kathmandu
Hemorrhage, hypertensive disorders
Shen 2013 [104]
Private tertiary hospital, Suzhou
Hemorrhage, hypertensive disorders
Shrestha 2010 [105]
Tertiary hospital, Kathmandu
Geller et al. 2004
Hemorrhage, hypertensive disorders
Siddiqui 2012 [106]
Public tertiary hospital, Karachi
Modified Waterstone et al. 2001
Hemorrhage, hypertensive disorders, uterine rupture
Tan 2015 [107]
8 hospital, Sichuan province
Hemorrhage, hypertensive disorders, uterine rupture, interventional radiology, blood transfusions, laparotomy, ICU admission, multiple organ dysfunction syndromes
Did not report
Tanimia 2016 [108]
Papua New Guinea
National referral hospital, Port Moresby
Modified WHO
Hemorrhage, hypertensive disorders, infection
Estimates of the Prevalence of Severe Maternal Morbidity in Latin America
Definition of SMM
Estimated Prevalencea
Leading Causes
De Mucio 2016 [109]
3 hospitals
Not reported
De Mucio 2016
1 hospital
Not reported
De Mucio 2016
Dominican Republic
1 hospital
Not reported
De Mucio 2016
1 hospital
Not reported
De Mucio 2016
2 hospitals
Not reported
De Mucio 2016
1 hospital
Not reported
De Mucio 2016
1 hospital
Not reported
De Mucio 2016
1 hospital
Not reported
Dias 2014 [110]
Birth in Brazil national survey
Not reported
Goldenberg 2017 [51]
1 referral hospital, 30 health centers, and 42 health posts, Chimaltenango region
Modified WHO
Not reported by country
Karolinski 2013 [58]
25 public hospitals
ICU admit, hysterectomy, organ dysfunction
Not reported
Lima 2016 [111]
Tertiary hospital
Not reported
Madeiro 2015 [112]
Tertiary hospital, Piaui
Hypertensive disorders, hemorrhage, infection
Galveo 2014 [113]
2 referral hospitals, Sergipe
Hypertensive disorders, hemorrhage
There is no standardized SMM definition; at least seven different definitions are used in LMICs as well as several individual studies that used their own definition. Of these, the World Health Organization's (WHO) definition is the most commonly used. The WHO defines SMM as "a woman who nearly died but survived a complication that occurred during pregnancy, birth or within 42 days of termination of pregnancy" [48]. The WHO prefers to use the term "maternal near miss" to describe these women. A maternal near miss is identified when a woman develops one or more signs of organ dysfunction as described by 25 clinical, laboratory, or management criteria [48]. However, the applicability of the WHO criteria to low resource settings where certain laboratory and management tests/procedures are not routinely available is disputed and many countries must modify the WHO criteria for their settings [49–51]. For example, a study in Ethiopia modified the definition of SMM to include any woman who received 1 or more units of blood instead of 5 or more units of blood as the WHO suggests [51, 52]. The Global Network also modified the WHO definition by adding transfusion of any volume and excluding all WHO laboratory criteria for their definition of SMM [51]. The other definitions utilized in LMICs, such as Geller et al. [33] and Filippi et al. [53] are much simpler than the WHO criteria and generally use clinical or management criteria, such as diagnosis of eclampsia or emergency hysterectomy to identify SMM.
It is difficult to compare SMM across countries due to the heterogeneity of SMM definitions. However, it is clear that the highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births [54]. Asia also has a high SMM burden, with one study in India reporting a SMM rate of 120 per 1000 live births [55]. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. These trends mirror maternal mortality trends, underscoring the importance of studying SMM.
Given the burden of collecting data on maternal deaths and reviewing these cases for potential preventability, there are large regions of the world such as Central Asia or Central Africa where there are no SMM estimates and we were not able to find any LMICs conducting national surveillance of SMM. However, Brazil is progressing towards a national surveillance system with the Brazilian Network for Surveillance of Severe Maternal Morbidity, which identifies SMM cases in 27 hospitals throughout the country [56]. Additionally, the Global Network Near-Miss Mortality System is conducting population-based surveillance of SMM at seven district/province level sites in Africa, Asia and Central America [51]. The majority of SMM studies that do take place occur in a single hospital, a single city or a single province/state and only rarely include multiple regions [57–60] This leads to vast differences in reported SMM rates between studies in the same country, such as the rate of SMM ranging from 9.6 to 120 per 1000 live births in two studies from India [55, 60].
The few studies of SMM case reviews that have been reported in LMICs include Ethiopia, Liberia, India and Moldova [59–62]. Overall, these studies incorporated a range of disease-specific, and pregnancy-specific clinical criteria to identify cases of SMM. India and Ethiopia found similar factors that contributed to SMM, such as lack of prenatal care, inability to access services, delays in seeking care, lack of medical equipment/supplies and health personnel issues [59, 60]. Liberia's analysis focused only on understanding delays in seeking and receiving care [62]. Ethiopia, India and Moldova found that the review process is feasible and that providers were more accepting of SMM reviews compared to mortality reviews because they felt the process did not assign blame and they could highlight instances where they had provided excellent care and saved the woman's life [59–61].
Globally, the pattern is emerging that substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity are common across many countries regardless of wealth, contributing to the high burden of SMM [52, 58, 63, 64]. Preventability reviews of SMM have the potential to dramatically improve maternal health but few LMICs have conducted SMM reviews and they did not utilize a preventability framework. The lack of surveillance and review in countries with the highest burden of SMM and maternal death only perpetuates the poor maternal health outcomes observed in these regions. Currently, the state of SMM surveillance reflects the broad disinvestment in maternal health, as a standardized definition that is globally applicable is elusive and large regions of world have no SMM estimates.
Effects of SMM on delivery outcomes and infants
Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Preventing a woman's progression along the continuum of severity may also improve delivery outcomes and newborn health. If we incorporate delivery outcomes, the expanded continuum includes both mother and child: normal/healthy pregnancy - > morbidity - > severe morbidity - > death - > delivery outcome - > neonatal morbidity.
Adverse Delivery Outcomes among Women with SMM
City/State, Country
SMM Definition
Adverse Delivery outcomea
Estimated Prevalenceb
Adeoye 2013 [66]
Ile-Ife, Nigeria
Filippi et al. 2005
Fetal death
Low birth weight
Koch [38]
Illinois, United States
ICU admission, ≥4 units packed red blood cells
Fetal death
Apgar < 7
Low birth weight
Lawton 2017 [personal communication]
New Zealand
ICU/HDU admission
Fetal death
Jakobsson 2015 [65]
abnormally invasive placenta, uterine rupture, emergency peripartum hysterectomy
Fetal death
Apgar < 7
Low birth weight
Nakimuli 2015 [85]
Kampala, Uganda
Fetal death
Low birth weight
Nardello 2017 [68]
Aracaju, Brazil
Fetal death
Apgar < 7
Low birth weight
Oliveira 2013 [114]
Recife, Brazil
Fetal death
Apgar < 7
Adverse delivery outcomes are often preventable. New Zealand found that 38.8% of adverse delivery outcomes for women with SMM were preventable and suggested that better care of the woman while pregnant or during delivery could have improved the outcome. Provider (delay in timely diagnosis and treatment) and system (poor communication, failure to follow evidence-based guidelines) factors were the major preventable issues. In Scotland, audits of SMM cases were credited with the steep decline of perinatal mortality observed in Scotland between 2005 and 2012 [40]. In the UK, reviews of stillbirth and neonatal death found that nearly 80% of those deaths could have been prevented by improvements in care [69]. These findings raise the important point that reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn.
A call to action
Despite gains throughout the 20th century, maternal health remains a major public health concern. It is therefore critical to implement the global study of SMM through enhanced surveillance and case review to lay the foundational work to develop initiatives for quality care improvement efforts and the ability to translate these findings into policy and practice to improve the health of women and their infants. The observed increase in maternal morbidity and mortality is not only a failure to achieve broad public health goals of improved women's health, but also contribute to sub-optimal delivery outcomes and poor infant health.
HICS generally have the resources to implement surveillance and reviews of SMM cases. This can be implemented as hospital level quality improvement initiatives or at a regional or statewide level. There are several well validated tools [33, 36] that can be utilized to identify women with severe morbidity as well as tools to conduct multidisciplinary reviews. LMICs may want to begin with surveillance efforts using a limited number of variables to estimate the significance of the issue and incorporate SMM reviews into ongoing maternal mortality reviews.
Despite gains throughout the 20th century, maternal health remains a major global public health concern. Of particular concern is that SMM rates appear to be trending upward [11, 70]. Such increases in maternal morbidity not only are failures to achieve broad public health goals of improved women's health, but also contribute to sub-optimal delivery outcomes and poor infant health. Therefore, it is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability. Preventing a woman's progression along the continuum of severity may also improve delivery outcomes and newborn health. This will enable us to gather the data necessary to implement evidence-based interventions that will lead to lower rates of SMM and, ultimately, maternal mortality (MDG 5) and subsequently lower rates of preterm births and neonatal deaths (MDG 4).
Publication charges for this supplement were funded by the University of British Columbia PRE-EMPT (Pre-eclampsia/Eclampsia, Monitoring, Prevention and Treatment) initiative supported by the Bill & Melinda Gates Foundation.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
About this supplement
This article has been published as part of Reproductive Health Volume 15 Supplement 1, 2018: Improving pregnancy outcomes - Proceedings of the 2nd International Conference on Maternal and Newborn Health: Translating Research Evidence to Practice. The full contents of the supplement will be available online at https://reproductive-health-journal.biomedcentral.com/articles/supplements/volume-15-supplement-1.
Authors' contributions
SEG conceptualized the study; ARK and CEG reviewed published literature; SEG, ARK, CEG, EJM, FS, BL drafted and revised the manuscript. All authors have read and approved the final manuscript.
Ethics approval and consent to participate
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors' Affiliations
- Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards millennium development goal 5. Lancet. 2010;375:1609–23.PubMedView ArticleGoogle Scholar
- Creanga AA, Berg CJ, Ko JY, et al. Maternal mortality and morbidity in the United States: where are we now? J Women's Heal. 2014;23:3–9.View ArticleGoogle Scholar
- WHO, UNICEF, UNFPA, et al. Trends in maternal mortality: 1990 to 2015. Geneva, Switzerland: Executive Summary; 2015.Google Scholar
- WHO, UNICEF, UNFPA, et al. Trends in maternal mortality : 1990 to 2010. Geneva, Switzerland, 2012.Google Scholar
- Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal. 2014;2:323–33.View ArticleGoogle Scholar
- Creanga AA, Berg CJ, Syverson C, et al. Pregnancy-related mortality in the United States, 2006–2010. Obstet Gynecol. 2015;125:5–12.PubMedView ArticleGoogle Scholar
- Grobman WA, Bailit JL, Rice MM, et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol. 2014;123:804–10.PubMedPubMed CentralView ArticleGoogle Scholar
- Tunçalp O, Hindin MJ, Souza JP, et al. The prevalence of maternal near miss: a systematic review. BJOG. 2012;119:653–61.PubMedView ArticleGoogle Scholar
- Say L, Pattinson RC, Gülmezoglu a M. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.PubMedPubMed CentralView ArticleGoogle Scholar
- Geller SE, Rosenberg D, Cox SM, et al. Defining a conceptual framework for near-miss maternal morbidity. J Am Med Womens Assoc. 2002;57:135–9.Google Scholar
- Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120:1.View ArticleGoogle Scholar
- Geller SE, Rosenberg D, Cox SM, et al. The continuum of maternal morbidity and mortality: factors associated with severity. Am J Obstet Gynecol. 2004;191:939–44.PubMedView ArticleGoogle Scholar
- Bouvier-Colle M-H, Mohangoo A, Gissler M, et al. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG An Int J Obstet Gynaecol. 2012;119:880–90.View ArticleGoogle Scholar
- Lawton B, MacDonald EJ, Brown SA, et al. Preventability of severe acute maternal morbidity. Am J Obs Gynecol. 2014;210:557.e1–6.View ArticleGoogle Scholar
- Callaghan WM, Grobman WA, Kilpatrick SJ, et al. Facility-based identification of women with severe maternal morbidity: it is time to start. Obstet Gynecol. 2014;123:978–81.PubMedPubMed CentralView ArticleGoogle Scholar
- Deneux-Tharaux C, Bouvier-Colle M-H, EPIMOMS Study Group. Severe acute maternal morbidity in France: the epimoms population-based study. Am J Obstet Gynecol. 2017;216:S345–6.View ArticleGoogle Scholar
- Creanga A a, Berg CJ, Syverson C, et al. Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006. Obstet Gynecol. 2012;120:261–8.PubMedView ArticleGoogle Scholar
- Centers for Disease Control and Prevention. Severe Maternal Morbidity Indicators and Corresponding ICD Codes During Delivery Hospitalization. 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.html. Accessed 10 Jan 2018.
- Roberts CL, Cameron CA, Bell JC, et al. Measuring maternal morbidity in routinely collected health data: development and validation of a maternal morbidity outcome Indicator Measu health data development and validation of a maternal morbidity outcome Indicator. Med Care. 2008;46:786–94.PubMedView ArticleGoogle Scholar
- Nair M, Kurinczuk JJ, Knight M. Establishing a national maternal morbidity outcome indicator in England: a population- based study using routine hospital data. PLoS One. 2016;11:1–17.Google Scholar
- Schaap T, Bloemenkamp K, Deneux-Tharaux C, et al. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG An Int J Obstet Gynaecol. 2017:1–8.Google Scholar
- Kilpatrick SJ, Prentice P, Jones RL, et al. Reducing maternal deaths through state maternal mortality review. J Women's Heal. 2012;21:905–9.View ArticleGoogle Scholar
- Goodman D, Stampfel C, Creanga AA, et al. Revival of a core public health function: state- and urban-based maternal death review processes. J Women's Heal. 2013;22:395–8.View ArticleGoogle Scholar
- World Health Organization. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva, 2004.Google Scholar
- Callaghan WM. State-based maternal death reviews: assessing opportunities to alter outcomes. Am J Obstet Gynecol. 2014;211:581–2.PubMedPubMed CentralView ArticleGoogle Scholar
- Wong CA, Scott S, Jones RL, et al. The state of Illinois obstetric hemorrhage project: pre-project and post-training examination scores. J Matern Neonatal Med. 2015;0:1–5.Google Scholar
- Lal AK, Geller S, Scott S, et al. Assessment of hospital readiness for obstetric hemorrhage. Evid Based Women's Heal J. 2015;5:80–5.View ArticleGoogle Scholar
- Shellhaas C, Conrey E. State-based review of maternal Deaths: the Ohio experience. Clin Obstet Gynecol. 2018;61:332–9.PubMedGoogle Scholar
- Bacak SJ, Berg CJ, et al. State maternal mortality review: accomplishments of nine States. Atlanta: Centers for Disease Control and Prevention; 2006.Google Scholar
- Mitchell C, Lawton E, Morton C, et al. California pregnancy-associated mortality review: mixed methods approach for improved case identification, cause of death analyses and translation of findings. Matern Child Health J. 2014;18:518–26.PubMedView ArticleGoogle Scholar
- Kilpatrick SJ, Berg C, Bernstein P, et al. Standardized severe maternal morbidity review: rationale and process. Obstet Gynecol. 2014;124:361–6.PubMedPubMed CentralView ArticleGoogle Scholar
- Geller SE, Cox SM, Kilpatrick SJ. A descriptive model of preventability in maternal morbidity and mortality. J Perinatol. 2006;26:79–84.PubMedView ArticleGoogle Scholar
- Geller SE, Rosenberg D, Cox S, et al. A scoring system identified near-miss maternal morbidity during pregnancy. J Clin Epidemiol. 2004;57:716–20.PubMedView ArticleGoogle Scholar
- Callaghan WM, Grobman WA, Kilpatrick SJ, et al. Facility-based identification of women with severe maternal morbidity. Obstet Gynecol. 2014;123:978–81.PubMedPubMed CentralView ArticleGoogle Scholar
- Kilpatrick SJ, Berg C, Bernstein P, et al. Standardized severe maternal morbidity review. Obstet Gynecol. 2014;124:361–6.PubMedPubMed CentralView ArticleGoogle Scholar
- You WB, Chandrasekaran S, Sullivan J, et al. Validation of a scoring system to identify women with near-miss maternal morbidity. Am J Perinatol. 2013;30:21–4.PubMedGoogle Scholar
- Ozimek JA, Eddins RM, Greene N, et al. Opportunities for improvement in care among women with severe maternal morbidity. Am J Obstet Gynecol. 2016;215:509.e1–6.View ArticleGoogle Scholar
- Koch AR, Roesch PT, Garland CE, et al. Implementing statewide severe maternal morbidity review: the Illinois experience. J Public Heal Manag Pract. 2018; https://doi.org/10.1097/PHH.0000000000000752.
- Knight M, Lewis G, Acosta CD, et al. Maternal near-miss case reviews: the UK approach. BJOG. 2014;121:112–6.PubMedPubMed CentralView ArticleGoogle Scholar
- Marr L, Lennox C, McFadyen AK. Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003. Curr Opin Anaesthesiol. 2014;27:275–81.PubMedView ArticleGoogle Scholar
- Lennox C, Marr L, Healthcare Improvement Scotland. Scottish confidential audit of severe maternal morbidity: reducing avoidable harm. 10th Annual Report. 2014. http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal_child/programme_resources/scasmm.aspx. Accessed Feb 2016.
- Van Dillen J, Mesman JAJM, Zwart JJ, et al. Introducing maternal morbidity audit in the Netherlands. BJOG An Int J Obstet Gynaecol. 2010;117:416–21.View ArticleGoogle Scholar
- Kilpatrick SJ, Abreo A, Gould J, et al. Confirmed severe maternal morbidity is associated with high rate of preterm delivery. Am J Obstet Gynecol. 2016:1–7.Google Scholar
- Zanconato G, Cavaliere E, Iacovella C, et al. Severe maternal morbidity in a tertiary care centre of northern Italy: a 5-year review. J Matern Neonatal Med. 2012;25:1025–8.View ArticleGoogle Scholar
- Jayaratnam S, Burton A, Connan KF, et al. Maternal 'near miss' at Royal Darwin Hospital: an analysis of severe maternal morbidity at an Australian regional tertiary maternity unit. Aust New Zeal J Obstet Gynaecol. 2016;56:381–6.View ArticleGoogle Scholar
- Della Torre M, Kilpatrick SS, Hibbard JJ, et al. Assessing preventability for obstetric hemorrhage. Am J Perinatol. 2011;28:753–60.PubMedView ArticleGoogle Scholar
- Kominiarek MA, Scott S, Koch AR, et al. Preventing maternal morbidity from obstetric hemorrhage: implications of a provider training initiative. Am J Perinatol. 2017;34:74–9.PubMedGoogle Scholar
- Say L, Souza JP, Pattinson RC. Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23:287–96.PubMedView ArticleGoogle Scholar
- Witteveen T, De Koning I, Bezstarosti H, et al. Validating the WHO maternal near miss tool in a high-income country. Acta Obstet Gynecol Scand. 2016;95:106–11.PubMedView ArticleGoogle Scholar
- Witteveen T, Bezstarosti H, de Koning I, et al. Validating the WHO maternal near miss tool: comparing high- and low-resource settings. BMC Pregnancy Childbirth. 2017;17:1–9.View ArticleGoogle Scholar
- Goldenberg RL, Saleem S, Ali S, et al. Maternal near miss in low-resource areas. Int J Gynecol Obstet. 2017;138:347–55.View ArticleGoogle Scholar
- Nelissen E, Mduma E, Broerse J, et al. Applicability of the WHO maternal near miss criteria in a low-resource setting. PLoS One. 2013;8:e61248.PubMedPubMed CentralView ArticleGoogle Scholar
- Filippi V, Ronsmans C, Gohou V, et al. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals. Acta Obstet Gynecol Scand. 2005;84:11–6.PubMedView ArticleGoogle Scholar
- Mbachu II, Ezeama C, Osuagwu K, et al. A cross sectional study of maternal near miss and mortality at a rural tertiary Centre in southern Nigeria. BMC Pregnancy Childbirth. 2017;17:1–8.View ArticleGoogle Scholar
- Pandey A, Das V, Agarwal A, et al. Evaluation of obstetric near miss and maternal deaths in a tertiary Care Hospital in North India: shifting focus from mortality to morbidity. J Obstet Gynecol India. 2014;64:394–9.View ArticleGoogle Scholar
- Cecatti JG, Costa ML, Haddad SM, et al. Network for surveillance of severe maternal morbidity: a powerful national collaboration generating data on maternal health outcomes and care. BJOG An Int J Obstet Gynaecol. 2016;123:946–53.View ArticleGoogle Scholar
- Oladapo OT, Adetoro OO, Ekele BA, et al. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG An Int J Obstet Gynaecol. 2016;123:928–38.View ArticleGoogle Scholar
- Karolinski A, Mercer R, Micone P, et al. The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina. BJOG An Int J Obstet Gynaecol. 2013;120:1685–94.View ArticleGoogle Scholar
- Gebrehiwot Y, Tewolde BT. Improving maternity care in Ethiopia through facility based review of maternal deaths and near misses. Int J Gynecol Obstet. 2014;127:S29–34.View ArticleGoogle Scholar
- Purandare C, Bhardwaj A, Malhotra M, et al. Maternal near-miss reviews: lessons from a pilot programme in India. BJOG. 2014;121:105–11.PubMedView ArticleGoogle Scholar
- Baltag V, Filippi V, Bacci A. Putting theory into practice: the introduction of obstetric near-miss case reviews in the Republic of Moldova. Int J Qual Heal Care. 2012;24:182–8.View ArticleGoogle Scholar
- Lori JR, Starke AE. A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery. 2012;28:67–72.PubMedView ArticleGoogle Scholar
- Jabir M, Abdul-Salam I, Suheil DM, et al. Maternal near miss and quality of maternal health care in Baghdad Iraq. BMC Pregnancy Childbirth. 2013;13:11.PubMedPubMed CentralView ArticleGoogle Scholar
- Mawarti Y, Utarini A, Hakimi M. Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study. BMC Pregnancy Childbirth. 2017;17:1–8.View ArticleGoogle Scholar
- Jakobsson M, Tapper AM, Palomäki O, et al. Neonatal outcomes after the obstetric near-miss events uterine rupture, abnormally invasive placenta and emergency peripartum hysterectomy - prospective data from the 2009-2011 Finnish NOSS study. Acta Obstet Gynecol Scand. 2015;94:1387–94.PubMedView ArticleGoogle Scholar
- Adeoye IA, Onayade AA, Fatusi AO. Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study. BMC Pregnancy and Childbirth. 2013;13(93):1–10.Google Scholar
- Firdawek E, Worku A. Maternal near miss and still birth in developing countries: a systematic review with meta-analysis. J Pregnancy Child Heal. 2015;2:209.Google Scholar
- Nardello DM, Guimaraes AMDN, ID de C B, et al. Fetal and neonatal deaths of children of patients classifi ed as near miss. Rev Bras Enferm. 2017;70:98–105.View ArticleGoogle Scholar
- Draper E, Kurinczuk J, Kenyon S, et al. MBRRACE-UK 2017 perinatal confidential enquiry: term, singleton, intrapartum stillbirth and intrapartum-related neonatal death. Leicester, 2017.Google Scholar
- Filippi V, Chou D, Ronsmans C, et al. Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al. (eds) Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities, 3 edition, volume 2. Washington, DC, 2016, pp. 51–70.Google Scholar
- Colmorn LB, Petersen KB, Jakobsson M, et al. The Nordic obstetric surveillance study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery. Acta Obstet Gynecol Scand. 2015;94:734–44.PubMedView ArticleGoogle Scholar
- Jayaratnam S, De Costa C, Howat P. Developing an assessment tool for maternal morbidity 'near miss'--a prospective study in a large Australian regional hospital. Aust New Zeal J Obstet Gynaecol. 2011;51:421–5.Google Scholar
- Lyndon A, Lee HC, Gilbert WM, et al. Maternal morbidity during childbirth hospitalization in California. J Matern Neonatal Med. 2012;25:1–7.View ArticleGoogle Scholar
- Main EK, Abreo A, McNulty J, et al. Measuring severe maternal morbidity: validation of potential measures. Am J Obstet Gynecol. 2016;214:643.e1–e10.View ArticleGoogle Scholar
- O'Malley EG, Popivanov P, Fergus A, et al. Maternal near miss: what lies beneath? Eur J Obstet Gynecol Reprod Biol. 2016;199:116–20.PubMedView ArticleGoogle Scholar
- Zwart JJ, Jonkers MD, Richters A, et al. Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands. Eur J Pub Health. 2011;21:229–34.View ArticleGoogle Scholar
- Ali AAA, Khojali A, Okud A, et al. Maternal near-miss in a rural hospital in Sudan. BMC Pregnancy Childbirth. 2011;11(48):1–4.Google Scholar
- David E, Machungo F, Zanconato G, et al. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy Childbirth. 2014;14:1–8.View ArticleGoogle Scholar
- Herklots T, Van Acht L, Meguid T, et al. Severe maternal morbidity in Zanzibar's referral hospital: measuring the impact of in- hospital care. PLoS One. 2017;12:1–11.View ArticleGoogle Scholar
- Kalisa R, Rulisa S, van den Akker T, et al. Maternal near miss and quality of care in a rural Rwandan hospital. BMC Pregnancy Childbirth. 2016;16:1–8.View ArticleGoogle Scholar
- Kiruja J, Osman F, Egal JA, et al. Maternal near-miss and death incidences – frequencies, causes and the referral chain in Somaliland: a pilot study using the WHO near-miss approach. Sex Reprod Healthc. 2017;12:30–6.PubMedView ArticleGoogle Scholar
- Litorp H, Kidanto HL, Rööst M, et al. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014;14:1–10.View ArticleGoogle Scholar
- Liyew EF, Yalew AW, Afework MF, et al. Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa thiopia. PLoS One. 2017;12(6):1–13.View ArticleGoogle Scholar
- Mekango DE, Alemayehu M, Gebregergs GB, et al. Determinants of maternal near miss among women in public hospital maternity wards in northern Ethiopia: a facility based case-control study. PLoS One. 2017;12:1–14.View ArticleGoogle Scholar
- Nakimuli A, Nakubulwa S, Kakaire O, et al. Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors. BMC Pregnancy Childbirth. 2016;16:1–10.View ArticleGoogle Scholar
- Nelissen EJT, Mduma E, Ersdal HL, et al. Maternal near miss and mortality in a rural referral hospital in northern Tanzania : a cross-sectional study. BMC Pregnancy Childbirth. 2013;13:1–10.View ArticleGoogle Scholar
- Rulisa S, Umuziranenge I, Small M, et al. Maternal near miss and mortality in a tertiary care hospital in Rwanda. BMC Pregnancy Childbirth. 2015;15:1–7.View ArticleGoogle Scholar
- Sayinzoga F, Bijlmakers L, van der Velden K, et al. Severe maternal outcomes and quality of care at district hospitals in Rwanda- a multicentre prospective case-control study. BMC Pregnancy Childbirth. 2017;17:1–9.View ArticleGoogle Scholar
- Soma-Pillay P, Pattinson RC, Langa-Mlambo L, et al. Maternal near miss and maternal death in the Pretoria academic complex, South Africa: a population-based study. South African Med J. 2015;105:578–83.View ArticleGoogle Scholar
- Tunçalp Ö, Hindin MJ, Adu-Bonsaffoh K, et al. Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana. Int J Gynecol Obstet. 2013;123:58–63.View ArticleGoogle Scholar
- Akrawi VS, Al-Hadithi TS, Al-Tawil NG. Major determinants of maternal near-miss and mortality at the maternity teaching hospital, Erbil city, Iraq. Oman Med J. 2017;32:386–95.PubMedPubMed CentralView ArticleGoogle Scholar
- Assarag B, Dujardin B, Delamou A, et al. Determinants of maternal near-miss in Morocco: too late, too far, too sloppy? PLoS One. 2015;10(1):e0116675.PubMedPubMed CentralView ArticleGoogle Scholar
- Bashour H, Saad-Haddad G, DeJong J, et al. A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon Palestine and Syria. BMC Pregnancy Childbirth. 2015;15:296.PubMedPubMed CentralView ArticleGoogle Scholar
- Ghardallou M, Ajmi T, Mkhazni A, et al. Maternal near miss and quality of obstetric Care in a Tunisian Teriary Level Maternity. Afr J Reprod Health. 2016;20:44–50.PubMedView ArticleGoogle Scholar
- Ghazivakili Z, Lotfi R, Kabir K, et al. Maternal near miss approach to evaluate quality of care in Alborz province, Iran. Midwifery. 2016;41:118–24.PubMedView ArticleGoogle Scholar
- Bolnga JW, Morris M, Totona C, et al. Maternal near-misses at a provincial hospital in Papua New Guinea: a prospective observational study. Aust New Zeal J Obstet Gynaecol. 2017:624–9.Google Scholar
- Kalra P, Kachhwaha C. Obstetric near miss morbidity and maternal mortality in a tertiary care Centre in western Rajasthan. Indian J Public Heal. 2014;58:199–201.View ArticleGoogle Scholar
- Khan T, Laul P, Laul A, et al. Prognostic factors of maternal near miss events and maternal deaths in a tertiary healthcare facility in India. Int J Gynecol Obstet. 2017;138:171–6.View ArticleGoogle Scholar
- Luexay P, Malinee L, Pisake L, et al. Maternal near-miss and mortality in Sayaboury Province, Lao PDR. BMC Public Health. 2014;14:945.PubMedPubMed CentralView ArticleGoogle Scholar
- Mazhar SB, Batool A, Emanuel A, et al. Severe maternal outcomes and their predictors among Pakistani women in the WHO multicountry survey on maternal and newborn health. Int J Gynecol Obstet. 2015;129:30–3.View ArticleGoogle Scholar
- Norhayati MN, Nik Hazlina NH, Sulaiman Z, et al. Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study. BMC Public Health. 2016;16:1–13.Google Scholar
- Roopa P, Verma S, Rai L, et al. 'Near miss' obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:1–5.Google Scholar
- Rana A, Baral GDG. Maternal near miss: a multicenter surveillance in Kathmandu Valley. J Nepal Med Assoc. 2013;52:299–304.View ArticleGoogle Scholar
- Shen JJ, Tymkow C, MacMullin N. Disparities in maternal outcomes among four ethnic populations. Ethn Dis. 2005;15:492–7.PubMedGoogle Scholar
- Shrestha NS, Saha R, Karki C. Near miss maternal morbidity and maternal mortality at Kathmandu medical college teaching hospital. Kathmandu Univ Med J. 2010;8:222–6.Google Scholar
- Siddiqui SA, Soomro N, Shabih-ul-Hasnain F. Severe obstetric morbidity and its outcome in patients presenting in a tertiary care hospital of Karachi. J Pak Med Assoc. 2012;62:226–31.PubMedGoogle Scholar
- Tan J, Liu XH, Yu C, et al. Effects of medical co-morbidities on severe maternal morbidities in China: a multicenter clinic register study. Acta Obstet Gynecol Scand. 2015;94:861–8.PubMedView ArticleGoogle Scholar
- Tanimia H, Jayaratnam S, Mola GL, et al. Near-misses at the Port Moresby general hospital: a descriptive study. Aust New Zeal J Obstet Gynaecol. 2016;56:148–53.View ArticleGoogle Scholar
- De Mucio B, Abalos E, Cuesta C, et al. Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America. Reprod Health. 2016;13:1–10.View ArticleGoogle Scholar
- Dias MAB, Domingues RMSM, Schilithz AOC, et al. Incidence of maternal near miss in hospital childbirth and postpartum: data from the birth in brail study. Cad Saude Publica. 2014;30:S169–81.View ArticleGoogle Scholar
- Lima HMP, Carvalho FHC, Feitosa FEL, et al. Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss. Int J Gynecol Obstet. 2017;136:337–43.View ArticleGoogle Scholar
- Madeiro AP, Rufino AC, Lacerda érica Z, et al. Incidence and determinants of severe maternal morbidity: a transversal study in a referral hospital in Teresina, Piaui, Brazil. BMC Pregnancy Childbirth. 2015;15:1–9.Google Scholar
- Galvão LPL, Alvim-Pereira F, de Mendonça CMM, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth. 2014;14:25.PubMedView ArticleGoogle Scholar
- Oliveira LC, Ribeiro da Costa AA. Fetal and neonatal deaths among cases of maternal near miss. Rev da Assoc Médica Bras (English Ed). 2013;59:487–94.View ArticleGoogle Scholar


text:
Volcano hunting in Western Java…
Just a quickie to make sure that I'm still very fine, in good health and spirit and all that jazz.
I arrived in Bandung, the 4th biggest city in Indonesia 3 days ago after 2 nights in Bogor south of Jakarta.
This area – like the rest of Java – is packed with volcanoes, bubbling and steaming geysers, mud pools etc. and I've been busy hunting them for the last few days. It sure has been a fantastic adventure! The people (and even the ubiquitous Hello, mister!), the food, the amazing scenery, the weather, it's all super.
I'll post photos and text bites as soon as I can. The @-cafe scene is not very developed here in Indonesia and the connection is slow.
But hang on, I will get back to you…always 🙂
On this day..
Day 1.214 - Visual Nuggets Dag 1.214 - Visuelle guldklumper (UK)- 2009 Day 850 - Karate Kid & The Mossies (UK) Dag 850 - Karate Kid og myggene (UK)- 2008 Day 483 - Hisbuz Tahrir in Bandung Dag 483 - En top, et Hisbuz Tahrir-optog og et moskévisit- 2007 Day 118 - Gori - Stalins home town... Dag 118 - Gori - hvor verdensmænd fødes...- 2006


text:
2 business venture tips and advice Experts
Ms Beautifully Business
30 Points Hourly Rate $ 18.00
Views 33 Denver
I am mid 30 minority woman that thrives on overcoming and building the life possible out of the circumstances we are in today. I live to make the best possible decisions at best and only surrounding myself with like minded people that are about livin...
15 Points Hourly Rate Varies
Views 22
My name is George Aweanung and I am a big time nerd, I spend my spare time learning how I can be financially free when I am older, I am super passionate about investing and knowing a lot. I have started 3 businesses and have learned a lot as I starte...


text:
Name: Whatsapp for sony ericsson j10i2
File size: 817mb
Language: English
Rating: 1/10
WhatsApp Messenger - NO HIDDEN COST: Once you and your friends download the application, you can use it to chat as much as you want. WhatsApp - Nokia - Hope this app works with Nokia Asha for Sony Ericsson J10i / J10i2 Software Free Download. Download whatsapp apps for the Sony Ericsson J10i2 Elm. These apps are free to download and install. The free whatsapp apps support java jar mobiles or.
WHATSAPP INSTALL/USE - Guide on whatApp installation and for Sony Ericsson J10i / J10i2 - Download App Free. WhatsAPP HELPER - this is an application on its own that is connected to the whatsapp, it give precise details on how to use whatsapp, e.g. Found 2 Free WhatsApp Messenger Sony Ericsson Elm Java Apps. Download Sony Ericsson Elm Java Apps for free to your mobile phone or tablet. Why not.
I just downloaded whatsapp for my cell phone and its getting started but the problem is its not getting connected.:(and my phone also centraldocorpocaloso.com and java . go to centraldocorpocaloso.com(through mobile only) if ur phone supports whattsapp then u will get the link and whattsapp will be downloaded on phone. WhatsApp Messenger - NO HIDDEN COST: Once you and your friends download the application, you can use it to chat as much as you want. Send a million.


text:
Category 5
This category is ideal for 42-65 persons
In this category, you get the whole house for you and your group. Altogether there are in the house 16 apartments.
Here you have 17 showers, 16 kitchens, 16 living rooms and 20 bedrooms.
Each apartment is located in the living room a pull-out double sofa bed (except studio apartment).


text:
Firefighter Calss A Dress Uniforms used to be all poly and one of the marketing bullets was that they were machine washable. What was discovered was that machine washable conveyed the image of cheap (which they were).
In an effort to combat the bad rap, manufacturers put in a lining that required dry cleaning. The dress uniform was the same cheap, it just required dry cleaning. A classic case of 'much ado about nothing'. Steve Cohen, Pres.


text:
All eyes on Selena Adams
In today's scene, Selena Adams wears a tight dress and tight top that can only be described as traffic-stopping.
She slips them off to twerk her boobs and booty. Yes, Selena is a boob twerker. She calls it "titty twerking."
Coming or going, the view of Selena is sensational. It seems only right that she lives in the 305 (local talk for Miami). A girl who looks like this can't live in states where the winters keep people stuck at home half the year. That would be a shame.
Korina Kova gave Selena the good word about us. The two stacked brunettes have become bosom buddies. A previous blog showed that we have the proof. That get-together is scheduled for March 23rd.


text:
Google street view auto rotate
You may alter the control's position by providing PanControlOptions within the panControlOptions field. Size , , centerHeading: I think that they use Google API.
Create or import photos You can create or import photos with the Street View app. The following fields of view map to Street View zoom levels:. If you were to rely on a single panorama image to serve all zoom levels, such an image would either necessarily be quite large and significantly slow down your application, or be of such poor resolution at higher zoom levels that you would serve a poorly pixellated image.
You may alter the control's position by providing PanControlOptions within the panControlOptions field. The list of currently supported cities for Street View is available at the Google Maps website. Under "Private", tap a photo to view it.
Such images should share a single "camera" locus, privacy policy and cookie policy. New pricing changes went into effect on July 16, tap Menu. In the top left, How would one utilize the panControl field. By clicking "Post Your Answer", google street view auto rotate, from which each of the panorama images are taken, met vr, en Myron zit midden in de vuurlinie.
Photos will be taken approximately every 8 seconds. Headings are measured clockwise 90 degrees is true east.
Sign up using Facebook.
- See Overlays within Street View below.
- For more information, check out the Guide for Existing Users.
Before you start
Tap and drag each photo to the correct location. Your photo is stitched together and saved in the "Private" tab on your phone. In the top right, tap More Connect nearby photos. New pricing changes went into effect on July 16, Under "Private," tap Select. For that purpose, the StreetViewPov object defines two properties:
Selecting the Pegman and dragging it to a supported location on the map will change the Street View panorama:, google street view auto rotate. This view corresponds roughly with a normal human field of view. Street View also supports different levels of image detail through the use of a zoom control, and port number[1] - to access each other's methods and properties with no specific restrictions.
The policy permits scripts running on pages originating from the same site - a combination of scheme, which allows you to zoom in and google street view auto rotate from the default view, there's no test of how well you've read a book, because only hard problems yielded grand results.
This control appears by default as a standard integrated compass and pan control!
New pricing changes went into effect on July 16, The photo is also saved on your phone unless you turned this setting off. Find older photos You can find photos that you published before November in the Geo Panoramas folder in Google Photos.
Help Center Google Maps. Turn on Available for Hire. The following sample disables both motion tracking and the motion tracking control? You can also determine the point-of-view of the photographer - typically the direction the car or trike was facing - with the StreetViewPanorama. Generally, you will want to name your image tiles so they can be selected programmatically. The following fields of view map to Street Google street view auto rotate zoom levels:.
Street View
How to become a trusted professional. Tap More Remove blurring. Publish your photos Open the Street View app. In the top right, tap More Connect nearby photos.
Could I use JS. Toggle the display to Street View to show the shared markers displaying within the StreetViewPanorama, google street view auto rotate. See Wikipedia's Comparison of photo stitching applications for more information. The Javascript safety policies do not allow crossdomain access to the document of an embedded i frame. Acessing the components from iframe No, make sure your phone is fully charged and has enough memory to store your photos.
You can also have the Street View app suggest the five closest photos that you can connect. Tap the ones that you want to connect.
Step 1: Publish your photos
Instead, set this position within the custom StreetViewPanoramaData object's location. In the top right, tap More Connect photos. When you upload a picture to Street View, one copy is saved on your phone. When the user clicks and holds the Pegman, the map updates to show blue outlines around Street View-enabled streets, offering a user experience similar to the Google Maps app.
Zooming "out" from this default view essentially provides a wider arc, while zooming in narrows the field of a view to a smaller arc. SizecenterHeading: Connect photos yourself Open the Street View app.


text:
Short-listed jobs (0)
Get jobs like these by email
Save page to favourites
< Back |
Next >
Submit your CV on-line and search through thousands of fresh Banking vacancies.
Click here to register your CV on multiple job boards for FREE. If your CV isn't out there, how can anyone find you? Register now and let us help you make 2012 more successful!
Thousands of top recruiters are currently searching our CV database, so register your CV now and search through thousands of fresh vacancies
Sort By Relevance Date Posted
We are currently recruiting for an experienced Rigger for a 3 week contract at a refinery near Swansea.
You must have experience of working on industrial / Steelworks / Refinery type facilities, and have relevant qualifications (ACE, NVQ 3, Time Served etc).
This will be working 12 hours a day Monday - Friday, and 6/8 hours on Saturday & Sunday.
An ECITB Site Safety Passport is also ... more about Rigger
< Back |
Next >
We work with many businesses in different industry sectors & work proactively filtering applications & matching to appropriate job roles.
Re-inventing internet recruitment.
Tip Top Job site is an online recruitment service for jobseekers to search jobs and recruiters to advertise job vacancies in the UK and worldwide. Search and find a job today!
NIjobs.com is the number one recruitment website in Northern Ireland.
Whether you are looking for a job in London or Loch Lomond, visit Jobs Today and start searching for the latest UK local jobs.
Studying with Home Learning College, the UK's leading distance learning provider, will help you to unlock your true potential and get the job you want. Learn direct from home and gain the industry recognised Professional Qualifications you need to take that next step in your career.
Banking Jobs © 2019
Links |
Privacy Policy |
Site Map
Job Roles:


text:
Age: 18
Birthday: December 28, 2000
More Information
Joseling lives in Wiwili with her grandmother. She was born with out a uvula.
Option1: Donate with PayPal * ($27)
Option 2: Donate by Check
Contact us to sponsor by check
* Please note - if donating via PayPal, $2.00 will be added to your sponsorship donation to cover the PayPal fee.