Applying the new concept of maternal near-miss in an intensive care unit

• Main Authors: Fátima Aparecida Lotufo, Mary Angela Parpinelli, Samira Maerrawi Haddad, Fernanda Garanhani Surita, Jose Guilherme Cecatti
• Format: Article
• Language: English
• Published: Faculdade de Medicina / USP 2012-01-01
• Series: Clinics
• Subjects: Maternal mortality; Maternal near-miss; Organ dysfunction or failure; Obstetrical hemorrhage; Severe pre-eclampsia
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322012000300004
• ISSN: 1807-5932; 1980-5322

OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.