Near miss maternal morbidity.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal Health

Background:

• Auditing severe acute maternal morbidity (SAMM) is vital for assessing and enhancing maternity care standards.
• Understanding the incidence, organ dysfunction, and risk factors of SAMM is essential for targeted interventions.
• International comparisons of SAMM data help identify best practices and areas for improvement in obstetric care.

Purpose of the Study:

• To determine the incidence of severe acute maternal morbidity in the study population.
• To identify the underlying organ dysfunction and obstetric risk factors associated with SAMM.
• To compare findings with published international reports on severe maternal morbidity.

Main Methods:

• Prospective data collection over a 5-year period (1999-2003) from patients experiencing SAMM.
• Inclusion criteria: women delivering infants weighing >500g.
• Analysis of incidence, causes, risk factors, and comparison with international data.

Main Results:

• 53 cases of SAMM identified among 36,802 deliveries, yielding an incidence of 1.4/1000.
• Maternal mortality incidence was 5.4/100,000, with a SAMM to mortality ratio of 26.5:1.
• Massive obstetric hemorrhage (requiring ≥5 units packed red cells) occurred in 77% of SAMM cases.

Conclusions:

• Auditing severe acute maternal morbidity is feasible using simple clinical criteria.
• The incidence and etiology of SAMM in this unit are comparable to those in developed countries.
• Continuous local and national review of SAMM data is crucial for maintaining and improving clinical standards in maternity care.