title: Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Reichenheim
authors.forename: Flávio
authors.initials: F
authors.lastname: Zylbersztajn
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Moraes
authors.forename: Gustavo
authors.initials: G
authors.lastname: Lobato
mesh_terms: D000208:Acute Disease; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008428:Maternal Mortality; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011247:Pregnancy