Archives of Gynecology and Obstetrics

, Volume 280, Issue 3, pp 337–343

Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators


  • Michael E. Reichenheim
    • Social Medicine InstituteState University of Rio de Janeiro
  • Flávio Zylbersztajn
    • Social Medicine InstituteState University of Rio de Janeiro
  • Claudia L. Moraes
    • Social Medicine InstituteState University of Rio de Janeiro
    • Family Health ProgramEstácio de Sá University
    • Departamento de ObstetríciaInstituto Fernandes Figueira, Fundação Oswaldo Cruz

DOI: 10.1007/s00404-008-0891-1

Cite this article as:
Reichenheim, M.E., Zylbersztajn, F., Moraes, C.L. et al. Arch Gynecol Obstet (2009) 280: 337. doi:10.1007/s00404-008-0891-1



To assess the most commonly employed diagnostic indicators of severe maternal morbidity (obstetric near-miss).


Review of the literature from January 1989 to August 2008.


Fifty-one manuscripts met the eligibility criteria, and 96 indicators were utilized at least once. Admission to intensive care unit (n = 28 studies) was the indicator most frequently utilized, followed by eclampsia and hemorrhage (n = 27), blood transfusion (n = 26) and emergent hysterectomy (n = 24).


Considering these findings, a trial version of a 13-item instrument for diagnosing obstetric near-miss is proposed. It includes the indicators eclampsia, severe hypertension, pulmonary edema, cardiac arrest, obstetrical hemorrhage, uterine rupture, admission to intensive care unit, emergent hysterectomy, blood transfusion, anesthetic accidents, urea >15 mmol/l or creatinine >400 mmol/l, oliguria (<400 ml/24 h) and coma. Further studies should focus on consensual definitions for these indicators and evaluate the psychometric proprieties of this trial version.


Maternal mortalityPregnancy complicationsMorbidityMedical auditNear-miss

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© Springer-Verlag 2008