Obstetric near-miss cases among women admitted to intensive care units in Italy.
OBJECTIVE
Maternal near-miss defines a narrow category of morbidity encompassing potentially life-threatening episodes. The purpose of this study was to detect near-miss instances among women admitted to intensive care units or coronary units, analyze associated causes, and compute absolute and specific maternal morbidity rates in six Italian regions.


METHODS
Observational retrospective study.


METHODS
Six Italian regions representing 49% of all resident Italian women aged 15-49 years.


METHODS
The study population included all pregnant women aged 15-49 years admitted to intensive care units or coronary care units in the participating regions. Cases were defined as women aged 15-49 years resident in the participating regions, with one or more hospitalizations in intensive care for pregnancy or any pregnancy outcome between 2004 and 2005.


METHODS
Cases were identified through the Hospital Discharge Database. Enrolled cases were diagnosed according to the 9(th) International Classification of Diseases.


METHODS
Maternal near-miss rate (number of women experiencing an admission to intensive care units/all women with live or stillborn babies).


RESULTS
A total of 1259 near-miss cases were identified and the total maternal near-miss rate was 2.0/1000 deliveries. Seventy percent of the women were admitted to intensive care units or coronary units after a cesarean section. The leading associated risk factors were obstetric hemorrhage/disseminated intravascular coagulation (40%) and hypertensive disorders of pregnancy (29%).


CONCLUSIONS
Monitoring of near-miss morbidity in conjunction with mortality surveillance could help to identify effective preventive measures for potentially life-threatening episodes.
National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy. serena.donati@iss.it
Serena
S
Donati
Sabrina
S
Senatore
Alessandra
A
Ronconi
D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D016638:Critical Illness / Q000453:epidemiology*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008428:Maternal Mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055815:Young Adult