Research Article
Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study
Table 1
The WHO set of severity markers (life-threatening conditions) used in maternal near miss assessments.
| | Group A | Group B |
| Cardiovascular dysfunction | Shock | pH < 7.1 | Lactate > 5 | Use of continuous vasoactive drugs | | Cardiac arrest | | Cardiopulmonary resuscitation (CPR) |
| Respiratory dysfunction | Acute cyanosis | Gasping | Respiratory rate >40 or <6/min | PaO2/FiO2 < 200 mmHg | Oxygen saturation <90% for ≥60 minutes | Intubation and ventilation not related to anesthesia |
| Renal dysfunction | Oliguria nonresponsive to fluids or diuretics | Creatinine ≥300 mmol/L or ≥3.5 mg/dL | | Dialysis for acute renal failure |
| Coagulation/hematological dysfunction | Clotting failure | Acute thrombocytopenia (<50 000 platelets) | Transfusion of ≥5 units of blood/red cells | |
| Hepatic dysfunction | Jaundice in the presence of preeclampsia | Bilirubin >100 mmol/L or >6.0 mg/dL |
| Neurological dysfunction | Metabolic coma (loss of consciousness AND the presence of glucose and keto acids in urine) | Coma/loss of consciousness lasting 12 hours or more | Stroke | | Status epilepticus/uncontrollable fits/total paralysis | |
| Uterine dysfunction | Hysterectomy due to infection or hemorrhage | |
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Source: reference [18].
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