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Applying the new concept of maternal near-miss in an intensive care unit


Introduction: The World Health Organization (WHO) recommended the investigation of near-miss as benchmark practice for monitoring maternal healthcare, and standardized the criteria for diagnosis. Objectives: to study maternal morbidity and mortality among women admitted to a general intensive care unit (ICU) during pregnancy or in the postpartum period, using the new WHO criteria. Methods: in a cross-sectional study, 158 cases of severe maternal morbidity (SMM) were classified according to the outcome into: death, maternal near-miss and potentially life-threatening conditions (PLTC). The health indicators for obstetric care were calculated. Bivariate analysis was performed using the chi-square test with Yate's correction or Fisher's exact test. Multiple regression analysis was used to calculate crude and adjusted odds ratios (OR), together with their respective 95% confidence intervals (95%CI). Results: Among the 158 admissions, 5 women died and 43 cases of maternal near-miss and 110 of PLTC occurred. The near-miss ratio was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 cases for each maternal death and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission for 67.7% of cases (107/158); however, haemorrhage was the main cause of maternal near-miss and death (17/43 cases of near-miss and 2/5 cases death), mainly due to uterine atony and complications of an ectopic pregnancy. Conclusions: Hypertension was the main cause of admission and of PLTC, however haemorrhage was the main primary determinant of maternal near-miss and death at this institution, suggesting that delays may occur in implementing appropriate obstetric care. (AU)

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