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 LobatoEmail author



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 mortality Pregnancy complications Morbidity Medical audit Near-miss 



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

Conflict of interest statement



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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
    Email author
  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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