SEVERE ACUTE MATERNAL MORBIDITY - A PILOT-STUDY OF A DEFINITION FOR ANEAR-MISS

Objective To test the application of a clinical definition of severe a cute maternal morbidity. Design A one-year prospective descriptive mul ti-centre study. Setting Kalafong and Pretoria Academic hospitals, cat ering for the delivery of indigent women in the Pretoria Health Region . Methods A 'near-miss' describes a patient with an acute organ system dysfunction, which if not treated appropriately, could result in deat h. The case notes of women fitting this definition and all maternal de aths were analysed and compared. Outcome measure Determine the primary obstetric factors and the organ systems that failed. Identification o f episodes of sub-standard care and missed opportunities. Results One hundred and forty-seven near misses and 30 maternal deaths were identi fied. The commonest reasons for a near-miss were: emergency hysterecto my in 42 women (29%); severe hypotension in 40 (27%); and pulmonary oe dema in 24 (16%). The most common initiating obstetric conditions were hypertension in 38 women (26%); haemorrhage in 38 (26%); and abortion or puerperal sepsis in 29 (20%). The primary obstetric factors amongs t the maternal deaths were: hypertension (33%); sepsis (27%); and mate rnal medical diseases (17%) in 10, 8 and 5 women respectively. Sub-sta ndard care was identified in 82 cases. Breakdown in the health care ad ministration was identified in 33, and patient-orientated missed oppor tunities on 34 occasions. Conclusions The definition of severe acute m aternal morbidity identified nearly five times as many cases as matern al death. This definition allows for an effective audit system of mate rnal care because it is clinically based, the definition is robust and the cases identified reflect the pattern of maternal death.