Archives of Gynecology and Obstetrics

, Volume 280, Issue 3, pp 337–343 | Cite as

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

  • Michael E. Reichenheim
  • Flávio Zylbersztajn
  • Claudia L. Moraes
  • Gustavo Lobato
Review

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.

Keywords

Maternal mortality Pregnancy complications Morbidity Medical audit Near-miss 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Michael E. Reichenheim
    • 1
  • Flávio Zylbersztajn
    • 1
  • Claudia L. Moraes
    • 1
    • 2
  • Gustavo Lobato
    • 3
  1. 1.Social Medicine InstituteState University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Family Health ProgramEstácio de Sá UniversityRio de JaneiroBrazil
  3. 3.Departamento de ObstetríciaInstituto Fernandes Figueira, Fundação Oswaldo CruzRio de JaneiroBrazil

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