The paradox of obstetric "near misses": converting maternal mortality into morbidity

To systematically review evidence of obstetric near-misses and their consequences.

PUBMED, OVID, and references of retrieved articles were used.

Only 13 original articles describe the occurrence of obstetric/maternal near-miss morbidity to date. All were included in this review, in addition to other articles related to the epidemiology and consequences of severe acute maternal morbidity.

Serious forms of maternal morbidity occur in about 1% of women in the United States compared to 3.01 to 9.05% in some developing settings. Worldwide, the leading causes of near-miss morbidity are hemorrhage and pregnancy-related hypertension or eclampsia/pre-eclampsia. These complications can have lasting effects, and their sequelae may result in maternal illness, injury and disability. Based on severity, we have provided three phenotypes of obstetric near-misses: Class I (near-miss with healthy infant); Class II (near-miss with feto-infant morbidity); Class III (near-miss with fetal/infant death).

Obstetric near-misses should be considered as potentially chronic illnesses that warrant follow-up care because the theoretical cycle of near-miss (as postulated in this paper) can only be interrupted by the resolution of residual issues or the mother's death. Some may consider near-miss events to be obstetric successes because ultimately the mother's life was spared, but the consequences of these complications can be overwhelming and enduring.