Skip to main content

Table 2 The WHO maternal near miss criteria: a woman presenting any of the following criteria life-threatening conditions and surviving a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy should be considered as a maternal near miss case [7]

From: National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

Dysfunctional system

Clinical criteria

Laboratory markers

Management based proxies

Cardiovascular

• Shock (a)

• pH<7.1

• Use of continuous vasoactive drugs (i)

 

• Cardiac arrest (b)

• Lactate>5 mEq/mL

• Cardio-pulmonary resuscitation (CPR)

Respiratory

• Acute cyanosis

• Oxygen saturation < 90% for ≥ 60 minutes

• Intubation and ventilation not related to anaesthesia

 

• Gasping (c)

• PaO2/FiO2<200 mmHg

 
 

• Respiratory rate >40 or <6 bpm

  

Renal

• Oliguria non responsive to fluids or diuretics (d)

• Creatinine ≥ 300 μmol/l or ≥ 3.5 mg/dL

• Dialysis for acute renal failure

Haematologic/

Coagulation

• Failure to form clots(e)

• Acute severe thrombocytopa-enia (<50,000 platelets/ml)

• Transfusion of ≥ 5 units of blood/red cells

Hepatic

• Jaundice in the presence of preeclampsia (h)

• Bilirubin >100 μmol/l or >6.0 mg/dL

 

Neurologic

• Any loss of consciousness lasting >12 h (f)

  
 

• Stroke (g)

  
 

• Uncontrollable fit/status epilepticus

  
 

• Total paralysis

  

Alternative severity proxy

  

• Hysterectomy following infection or haemorrhage

  1. a) Shock is a persistent severe hypotension, defined as a systolic blood pressure <90 mmHg for ≥ 60 minutes with a pulse rate at least 120 despite aggressive fluid replacement (>2 L)
  2. b) Cardiac arrest refers to the Loss of consciousness AND absence of pulse/heart beat
  3. c) Gasping is a terminal respiratory pattern and the breath is convulsively and audibly caught.
  4. d) Oliguria is defined as an urinary output <30 ml/hr for 4 hours or <400 ml/24 hr
  5. e) Clotting failure can be assessed by the bedside clotting test or absence of clotting from the IV site after 7–10 minutes
  6. f) Loss of consciousness is a profound alteration of mental state that involves complete or near-complete lack of responsiveness to external stimuli. It is defined as a Coma Glasgow Scale <10 (moderate or severe coma).
  7. g) Stroke is a neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours
  8. h) Pre-eclampsia is defined as the presence of hypertension associated with proteinuria. Hypertension is defined as a blood pressure of at least 140 mm Hg (systolic) or at least 90 mm Hg (diastolic) on at least two occasions and at least 4–6 h apart after the 20th week of gestation in women known to be normotensive beforehand. Proteinuria is defined as excretion of 300 mg or more of protein every 24 h. If 24-h urine samples are not available, proteinuria is defined as a protein concentration of 300 mg/L or more (≥ 1 + on dipstick) in at least two random urine samples taken at least 4–6 h apart
  9. i) For instance, continuous use of any dose of dopamine, epinephrine or norepinephrine
Back to article page

Reproductive Health

ISSN: 1742-4755