Applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model to predict the maternal outcome in near miss obstetric patients: a prospective observational study

  • Rubina PanditEmail author
  • Vanita Jain
  • Rashmi Bagga
  • Pooja Sikka
  • Kajal Jain
Maternal-Fetal Medicine



To assess the applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model in near miss (NM) obstetric patients


It was a prospective observational study conducted at a tertiary health care center from July 2015 to Feb 2016. All patients fulfilling one or more WHO NM criteria were included. MSS and MSI were calculated for all NM patients on admission. They were then followed up till the final outcome (NM or death). Each NM parameter, system-wise MSS, total MSS and MSI were then associated with the final outcome.


Of 4822 patients, 1739 had potentially life-threatening conditions of which 174 were identified as NM. The average MSS and MSI of patients who remained NM was 4.41 and 11.67%, respectively, and those who died was 9.47 and 58.16%, respectively. Both were found to be significantly associated with the outcome (p < 0.001). MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC – 0.838 [95% CI 0.766–0.910]). However, of 25 NM criteria, only 17 NM criteria and 3 system dysfunctions (cardiovascular, respiratory and neurological) were found to associate significantly with the outcome.


MSS and MSI act as good prognostic tools to assess the severity of maternal complications and estimate the probability of death in NM patients. As all NM parameters are not equally predictive of severity of maternal morbidity, different scores per NM parameter and system should be assigned while calculating MSS for better prognostication.


Near miss Maternal Severity Score Maternal Severity Index 



We would like to acknowledge the hospital staff and resident doctors for their valuable help in collecting all NM. We would also extend our gratitude to Dr Sandeep Satsangi for his contribution in manuscript preparation.

Author contributions

All authors contributed significantly to manuscript preparation. RP was involved in study setup, study design, data review and analysis, data management and drafting of manuscript. VJ conceived the study, participated in study design, data management and manuscript editing. RB and PS performed data review and edited the manuscript. KJ contributed in data analysis and manuscript editing.



Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethics approval

The study was reviewed and approved by the institute’s ethics committee, PGIMER, Chandigarh, on 11/9/2015 (Reference Number- NK/2210/MD/9907–08).

Informed consent

An informed written consent was obtained from patients/relatives after fully explaining the nature and purpose of study.

Research on animals or humans

This study did not involve any research conducted on animals. An informed written consent was obtained from patients/relatives after fully explaining the nature and purpose of study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of Reproductive MedicineCloudnine HospitalBangaloreIndia
  3. 3.Department of AnesthesiaPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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