Slovak Obstetric Survey System (SOSS)

The Slovak Obstetric Survey System (SOSS) is coordinated by the obstetricians and gynecologists from section of Perinatal medicine of Slovak Society of Obstetrics and Gynecology. The surveillance involved all obstetric units within Slovakia. Its primary objective is to collect and disseminate accurate data on severe maternal morbidity and maternal mortality, with the overarching aim of improving the quality of antepartum, intrapartum, and postpartum care in Slovakia.

Website: work in progress

Contact person: a.kristufkova@gmail.com

Mission statement

To provide reliable estimates of severe maternal morbidity and maternal mortality, identify key factors contributing to selected maternal morbidities and deaths, and promote targeted public health interventions to improve the quality of care during childbirth and prevent avoidable adverse outcomes.

Aims

Aligned with its mission, the Slovak Obstetrics Survey System pursues the following objectives:

• Estimating the incidence of severe maternal morbidities and identify contributing key factors
• Estimating the maternal mortality ratio (MMR) through complementary methodologies
• Identifying the main causes of maternal mortality
• Detecting clinical and organizational factors amenable to improvement
• Formulating evidence-based recommendations for clinical practice
• Providing ongoing training to healthcare professionals and strategies for prevention

Methods

Maternal deaths are identified using a combination of methods to reduce underreporting and misclassification:

1. Mandatory referral of maternal deaths
   Analyses of maternal deaths direct notifications from obstetric units or hospitals in Slovakia
2. Manual review of selected death certificates
   All death certificates of women of reproductive age are manually reviewed. Based on the information provided (immediate, antecedent, and underlying causes of death), two categories are selected for further investigation:
   • Deaths with an ICD-10 code from the obstetric chapter
   • Deaths mentioning pregnancy, childbirth, puerperium, or related conditions (potential misclassifications)
3. Enhances surveillance system
   Active search of maternal deaths in non-obstetrics hospital workplaces and mass media sources.
   Linkage to the SOSS register of severe acute maternal morbidity cases in Slovakia.

All identified cases are reviewed by an expert working group, which collects the full medical records, assigns the cause of death, and assesses preventability.

Severe acute maternal morbidity cases are identified using 3-step process of SOSS:

1. Number of selected severe acute maternal morbidity cases are annually reported to SOSS:

• Severe peripartum hemorrhage
• Peripartum hysterectomy
• Placenta accrete spectrum
• Uterine rupture
• Eclampsia
• HELLP syndrome
• Maternal sepsis (obstetric and non-obstetric causes)
• Transport of pregnant or women after childbirth to the intensive care unite
• Amniotic fluid embolism

2. The SOSS sends anonymous questionnaires for individual cases to obstetric units according to reported numbers
3. Expert analysis of returned questionnaires and confirmation/exclusion of cases.

History and Development

• Perinatal analyses together with maternal mortality is regularly analyzed from 2007
• SOSS was established in year 2012, after the close cooperation with the United Kingdom Obstetric Surveillance System (UKOSS – history started in 2005 year) due to “epidemy” of fatal amniotic fluid embolism in the years 2009 and 2010 in Slovakia. This fi rst collaboration raised into a comparison of amniotic fl uid embolism cases and to comparison of perinatal outcomes between Slovakia and UK. Since 2012 SOSS work on active surveillance of SAMM in Slovakia.