title: Applying the new concept of maternal near-miss in an intensive care unit.
abstract: OBJECTIVE
  The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria.
  
  
  METHODS
  In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals.
  
  
  RESULTS
  Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially life-threatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths).
  
  
  CONCLUSIONS
  Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.
authors.affiliation: University of Campinas, Obstetrics and Gynecology, Campinas/SP, Brazil.
authors.forename: Fátima Aparecida
authors.initials: FA
authors.lastname: Lotufo
authors.forename: Mary Angela
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Samira Maerrawi
authors.initials: SM
authors.lastname: Haddad
authors.forename: Fernanda Garanhani
authors.initials: FG
authors.lastname: Surita
authors.forename: Jose Guilherme
authors.initials: JG
authors.lastname: Cecatti
mesh_terms: D000293:Adolescent; D000328:Adult; D003643:Death; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008428:Maternal Mortality; D009774:Obstetrics / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000401:mortality*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000401:mortality*; D014944:World Health Organization; D055815:Young Adult