title: Developing an assessment tool for maternal morbidity 'near-miss'- a prospective study in a large Australian regional hospital.
abstract: BACKGROUND
  Maternal mortality is now a rare event in the developed world and its measurement is no longer a useful way of assessing obstetric care. Examination of cases of women who nearly died but survived a severe complication of pregnancy or childbirth - maternal 'near-misses' - is increasingly being recognised as potentially more useful, although severe maternal morbidity is much less easy to define and quantify than maternal death.
  
  
  OBJECTIVE
  To identify and assess prospectively cases of severe maternal morbidity presenting to Cairns Base Hospital (CBH), to define cases as near-misses and thereby develop a tool for future assessment of obstetric care in CBH and elsewhere.
  
  
  METHODS
  Based on approaches recommended by the recent WHO working group on Maternal Mortality and Morbidity classifications, a data collection form was constructed using a combination of named morbidities and specific interventions. Over 1 year data from all cases of severe maternal morbidity was collected and analysed both prospectively and retrospectively to identify true near-misses.
  
  
  RESULTS
  Seventeen cases of true near-misses were identified, giving a near-miss rate of six per 1000 live births for CBH in the study period; 64% of cases were attributable to obstetric causes and 36% to non-obstetric causes.
  
  
  CONCLUSIONS
  Collection of near-miss data has the potential to become a useful tool for the assessment of obstetric care in both in CBH and in other Australian hospitals but is time-consuming and requires continuous surveillance by medical staff if cases are not to be overlooked.
authors.affiliation: Department of Obstetrics and Gynaecology, Cairns Base Hospital, Queensland, Australia.
authors.forename: Skandarupan
authors.initials: S
authors.lastname: Jayaratnam
authors.forename: Caroline
authors.initials: C
authors.lastname: De Costa
authors.forename: Paul
authors.initials: P
authors.lastname: Howat
mesh_terms: D001315:Australia / Q000453:epidemiology; D003422:Critical Care; D003625:Data Collection; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology; D012640:Seizures / Q000453:epidemiology