Abstract:
BACKGROUND: To evaluate the performance of the WHO criteria for defining maternal near miss and identifying
deaths among cases of severe maternal morbidity (SMM) admitted for intensive care.
METHOD: Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18
died. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score
were retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die
defined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each
one of the six components of the score, being considered the gold standard for the diagnosis of maternal near
miss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum
SOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting
maternal death and also for identifying cases of organ failure were estimated.
RESULTS: The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent
criteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (≥1
h). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of
the 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near
miss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with
no failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve
of 0.897) for prediction of cases of maternal near miss according to the WHO criteria.
CONCLUSIONS: The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost
all cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently
enable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers.
