title: Near-misses at the Port Moresby General Hospital: a descriptive study.
abstract: BACKGROUND
  The World Health Organization (WHO) defines 'maternal near-miss' as 'a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy'. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care.
  
  
  OBJECTIVE
  Over a 15-month period, details of cases that could be classified as 'near-misses' were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital.
  
  
  METHODS
  Information about all cases that fitted the WHO definition of 'near-miss' was collected prospectively.
  
  
  RESULTS
  During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for 'maternal near-miss'; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the 'near-misses' were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses.
  
  
  CONCLUSIONS
  Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.
authors: Division of Obstetrics and Gynaecology, Port Moresby General Hospital, Boroko, Papua New Guinea.
authors: Hilda
authors: H
authors: Tanimia
authors: James Cook University College of Medicine, Cairns, Qld, Australia.
authors: Skandarupan
authors: S
authors: Jayaratnam
authors: Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
authors: Glen L
authors: GL
authors: Mola
authors: Division of Obstetrics and Gynaecology, Port Moresby General Hospital, Boroko, Papua New Guinea.
authors: Apeawusu B
authors: AB
authors: Amoa
authors: James Cook University College of Medicine, Cairns, Qld, Australia.
authors: Caroline
authors: C
authors: de Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D050498:Live Birth; D008428:Maternal Mortality; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D011295:Prenatal Care; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
keywords: maternal morbidity; maternal mortality; near-miss