Table 1.
Maternal near miss diagnostic criteria according to the World Health Organization(1)
| Clinical |
| Acute cyanosis |
| "Gasping" (terminal respiratory pattern in which breathing is laborious and audible) |
| Respiratory rate > 40 or < 6 breaths per minute |
| Shock (persistent severe hypotension, defined as SBP < 90mmHg for ≥ 60 minutes with a pulse of at least 120 beats per minute, despite liquid infusion [> 2L]) |
| Oliguria unresponsive to fluids or diuretics (urine output < 30mL/hour for 4 hours or < 400mL/24 hours) |
| Coagulation disorders (coagulation failure as assessed by a clotting assay or by the absence of coagulation after 7 to 10 minutes) |
| Loss of consciousness for 12 hours or more (defined as a score < 10 on the Glasgow Coma Scale) |
| Loss of consciousness and absence of a pulse or heartbeat |
| Stroke (neurological deficit of cerebrovascular cause that persists for more than 24 hours) |
| Uncontrolled convulsion |
| Jaundice in the presence of pre-eclampsia (pre-eclampsia is defined as the presence of hypertension associated with proteinuria. Hypertension is defined as SBP ≥ 140mmHg and/or DBP ≥ 90mmHg on at least two occasions, with an interval of 4 to 6 hours after the 20th week of pregnancy. Proteinuria is defined as excretion of 300mg or more protein in 24 hours, or ≥ 1 + proteinuria in at least two measurements with an interval of 4 to 6 hours) |
| Laboratory |
| SO2 < 90% for 60 minutes or more |
| PaO2/FiO2 < 200mmHg |
| Creatinine ≥ 300/µmol/L or ≥ 3.5mg/dL |
| Bilirubin ≥ 100µmol/L or ≥ 6.0mg/dL |
| pH < 7.1 |
| Lactate > 5 |
| Acute thrombocytopenia (< 50,000) |
| Loss of consciousness and presence of glucose and ketone in the urine |
| Treatment |
| Use of vasoactive drugs |
| Hysterectomy due to infection or hemorrhage |
| Transfusion ≥ 5 red blood cell units |
| Intubation and ventilation for ≥ 60 minutes unrelated to anesthesia |
| Dialysis for acute renal failure |
| Cardiorespiratory arrest |
SBP - systolic blood pressure; DBP - diastolic blood pressure; SO2 - oxygen saturation; PaO2/FiO2 - arterial oxygen partial pressure/fraction of inspired oxygen.