Table 2.
Criteria and definitions of severe maternal morbidity
Scottish Confidential Audit’s criteria and definition[[27]] | |
---|---|
1 |
Major obstetric haemorrhage |
|
Estimated blood loss ≥ 2500ml, or transfused 5 or more units of blood or received treatment for coagulopathy |
2 |
Eclampsia |
|
Seizure associated with antepartum, intrapartum or postpartum symptoms and signs of pre-eclampsia. |
3 |
Renal or liver dysfunction |
|
Acute onset of biochemical disturbance, urea > 15mmol/l, creatinine > 400mmol/l, AST/ALT > 200u/l. |
4 |
Cardiac arrest |
|
No detectable major pulse. |
5 |
Pulmonary oedema |
|
Clinically diagnosed pulmonary oedema associated with acute breathlessness and O2 saturation < 95%, requiring O2, diuretics or ventilation. |
6 |
Acute respiratory dysfunction Requiring intubation or ventilation for > 60 minutes (not including duration of general anaesthetic). |
7 |
Coma Including diabetic coma. Unconscious for > 12 hours. |
8 |
Cerebro-vascular event |
|
Stroke, cerebral/cerebellar haemorrhage or infarction, subarachnoid haemorrhage, dural venous sinus thrombosis. |
9 |
Status epilepticus |
|
Unremitting seizures in patient with known epilepsy. |
10 |
Anaphylactic shock |
|
An allergic reaction resulting in collapse with severe hypotension, difficulty breathing and swelling/rash. |
11 |
Septicaemic shock |
|
Shock (systolic blood pressure < 80 mm/Hg) in association with infection. No other cause for decreased blood pressure. Pulse of 120 beats/minute or more. |
12 |
Anaesthetic problem |
|
Aspiration, failed intubation, high spinal or epidural anaesthetic. |
13 |
Massive pulmonary embolism |
|
Increased respiratory rate (> 20/min), tachycardia, hypotension. Diagnosed as ‘high’ probability on V/Q scan or positive spiral chest CT scan. Treated by heparin, thrombolysis or embolectomy. |
14 |
Intensive care admission/ Coronary care admission |
|
Unit equipped to ventilate adults. Admission for one of the above problems or for any other reason. Include CCU admissions. |
Waterstone et al’s criteria and definition[[18]] | |
1 |
Severe preeclampsia |
|
Blood pressure 170/110 mm Hg on two occasions 4 hours apart or > 170/110 mm Hg once plus ≥ 0.3 g in 24 hours proteinuria or ≥ + + on dipstick |
|
OR |
|
Diastolic blood pressure > 90 mm Hg plus proteinuria (as above) on one occasion plus one of the following signs/symptoms: Oliguria (< 30 ml/h for 2 hours), Visual disturbances (flashing lights or blurred vision), Epigastric/right upper quadrant pain or tenderness, Thrombocytopenia (< 100x109/l) Pulmonary oedema |
2 |
Eclampsia |
|
Convulsions during pregnancy or in the first 10 days postpartum together with at least two of the following features within 24 hours after the convulsions: Hypertension (≥ 170/110 mm Hg), Proteinuria (≥ + on random dipstick analysis or ≥ 0.3 g in 24 hours) |
|
Thrombocytopenia (< 100x109/l), Increased aspartate aminotransferase (≥ 42 U/l) |
3 |
HELLP syndrome |
|
Haemolysis (abnormal peripheral smear or raised total bilirubin concentration (≥ 20.5 μmol/l)), raised liver enzyme activity (raised aspartate aminotransferase (≥ 70 U/l) or raised γglutamyltransferase (≥ 70 U/l), and low platelets (< 100x109/l)) |
4 |
Severe haemorrhage |
|
Estimated blood loss > 1500 ml, peripartum fall in haemoglobin concentration ≥ 40 g/l or acute transfusion of 4 or more units of blood |
5 |
Severe sepsis |
|
Sepsis is systemic response to infection manifested by two or more of: Temperature > 38°C or < 36°C (unless after prolonged caesarean), Heart rate > 100 beats/minute, Respiratory rate > 20/min or PaCO2 < 32 mmHg, White cell count > 17x109/l or < 4x109/l or > 10% immature forms, Plus bacteraemia (that is, positive blood cultures) or positive swab culture |
|
Severe sepsis is sepsis associated with one of: Organ dysfunction—for example, acute renal failure, Hypoperfusion—for example, lactic acidosis, oliguria, or acute alteration in mental state, Hypotension—that is, systolic blood pressure < 90 mm Hg or drop of > 40 mm Hg in the absence of other causes of hypotension |
6 |
Uterine rupture |
Acute dehiscence of the uterus leading to the emergency delivery of the infant |