title: Maternal 'near miss' at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit.
abstract: BACKGROUND
  Assessment of severe maternal morbidity using World Health Organization (WHO) 'near-miss' criteria is gaining in importance as a valuable tool in the assessment of maternity care of women. Identification of cases allows an understanding of aetiology of severe morbidity and factors contributing to poor maternal outcomes.
  
  
  OBJECTIVE
  The aim of this study is to determine the rate of maternal 'near miss' at Royal Darwin Hospital (RDH) and the utility of the WHO near-miss criteria as a tool for data collection in a regional Australian context.
  
  
  METHODS
  Cases of maternal 'near miss' and deaths were prospectively identified over a period of 12 months using the WHO criteria.
  
  
  RESULTS
  During the audit period, there were 2080 live births at Royal Darwin Hospital (RDH): 10 women presented with a 'near miss' and there was one maternal death. The maternal mortality ratio for the hospital was 48/100 000 live births, the maternal 'near-miss' index ratio was 4.8/1000 live births, and the combination of maternal deaths and near misses gave a severe maternal outcome (SMO) ratio of 5.3/1000 live births. The main cause of obstetric 'near miss' was obstetric haemorrhage. Indigenous women and women from remote areas comprised a significant portion of 'near-miss' cases.
  
  
  CONCLUSIONS
  The rates of maternal 'near miss' at RDH are consistent with other studies in the developed world. The WHO maternal 'near-miss' audit tool helps health professionals understand and anticipate severe maternal morbidities, with the aim of improving maternal and perinatal outcomes.
authors: Royal Darwin Hospital, Darwin, NT, Australia.|Hospital Nacional Guido Valadares (HNGV), Dili, Timor-Leste.
authors: Skandarupan
authors: S
authors: Jayaratnam
authors: Royal Darwin Hospital, Darwin, NT, Australia.|Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors: Alice
authors: A
authors: Burton
authors: Royal Darwin Hospital, Darwin, NT, Australia.|Tasmanian Obstetrics and Gynaecology Specialists - TasOGS, Hobart, TAS, Australia.
authors: Kirsten Fiona
authors: KF
authors: Connan
authors: Department of Medicine and Dentistry, James Cook University (JCU), Cairns, Qld, Australia.
authors: Caroline
authors: C
authors: de Costa
mesh_terms: D005260:Female; D006757:Hospital Units; D006801:Humans; D008428:Maternal Mortality; D008485:Medical Audit; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D015876:Northern Territory / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D062606:Tertiary Care Centers; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000209:etiology; D014944:World Health Organization
keywords: indigenous; maternal; morbidity; pregnancy