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

Arch Gynecol Obstet. 2009 Sep;280(3):337-43. doi: 10.1007/s00404-008-0891-1. Epub 2008 Dec 27.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Female
  • Health Status Indicators*
  • Humans
  • Maternal Mortality
  • Morbidity
  • Obstetric Labor Complications / diagnosis*
  • Obstetric Labor Complications / epidemiology*
  • Pregnancy