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

Source: reference [18].