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

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Abstract

Objective

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

Methods

Review of the literature from January 1989 to August 2008.

Results

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).

Conclusion

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.

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Acknowledgments

MER is partially supported by CNPq, Grant 306939/2003–7.

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Authors and Affiliations

  1. Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil

    Michael E. Reichenheim, Flávio Zylbersztajn & Claudia L. Moraes

  2. Family Health Program, Estácio de Sá University, Rio de Janeiro, Brazil

    Claudia L. Moraes

  3. Departamento de Obstetrícia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Avenida Rui Barbosa, 716, Rio de Janeiro, RJ, CEP 22250-020, Brazil

    Gustavo Lobato

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  1. Michael E. Reichenheim
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  2. Flávio Zylbersztajn
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  3. Claudia L. Moraes
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  4. Gustavo Lobato
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Correspondence to Gustavo Lobato.

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Reichenheim, M.E., Zylbersztajn, F., Moraes, C.L. et al. Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators. Arch Gynecol Obstet 280, 337–343 (2009). https://doi.org/10.1007/s00404-008-0891-1

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