Appendix 2.
Frequencies of maternal near-miss by type of organ system dysfunction in the four hospitals
| Facilities |
|||||
|---|---|---|---|---|---|
| A | B | C | D | Total | |
| Severe maternal complications | 52 | 16 | 4 | 0 | 72, 37.3% |
| Eclampsia | 17 | 7 | 2 | 0 | 26 |
| Sepsis or severe systemic infectionb | 22 | 2 | 2 | 0 | 26 |
| Uterine rupturec | 1 | 1 | 0 | 0 | 2 |
| Pulmonary oedema | 5 | 2 | 0 | 0 | 7 |
| Severe abortion complicationsd | 7 | 1 | 0 | 0 | 8 |
| Severe malariae | 0 | 4 | 0 | 0 | 4 |
| Severe pre-eclampsia with ICU admission | 1 | 3 | 0 | 0 | 4 |
| Laparotomy other than caesarean section or ectopic pregnancy | 12 | 0 | 0 | 0 | 12 |
| Cardiovascular dysfunction | 17 | 2 | 2 | 0 | 21, 10.8% |
| Shockf | 16 | 2 | 2 | 0 | 20 |
| Cardiac arrest | 0 | 0 | 0 | 0 | 0 |
| Use of continuous vasoactive drugs | 3 | 0 | 0 | 0 | 3 |
| CPR | 0 | 0 | 0 | 0 | 0 |
| pH < 7.1 | 1 | 0 | 0 | 0 | 1 |
| Lactate >5 mEq/mL | 0 | 0 | 0 | 0 | 0 |
| Respiratory function | 14 | 2 | 0 | 0 | 16, 8.3% |
| Acute cyanosis | 0 | 0 | 0 | 0 | 0 |
| Gasping | 0 | 0 | 0 | 0 | 0 |
| Respiratory rate >40 or <6/min | 4 | 1 | 0 | 0 | 5 |
| Intubation and ventilation for ≥60 minutes not related to anaesthesia | 10 | 1 | 0 | 0 | 11 |
| Oxygen saturation <90% for ≥60 minutes | 4 | 0 | 0 | 0 | 4 |
| Renal dysfunction | 3 | 1 | 0 | 0 | 4, 2.0% |
| Oliguria non-responsive to fluids or diureticsg | 3 | 1 | 0 | 0 | 4 |
| Creatinine ≥300µmol/l or ≥3.5mg/dL | 1 | 0 | 0 | 0 | 1 |
| Dialysis for acute renal failure | 1 | 0 | 0 | 0 | 1 |
| Coagulation/hematologic dysfunction | 112 | 24 | 6 | 5 | 147, 75.8% |
| Failure to form clots | 4 | 2 | 0 | 0 | 6 |
| Transfusion of ≥ 2 units of red blood cells | 108 | 21 | 6 | 5 | 140 |
| Acute thrombocytopenia (<50,000 platelets/ml) | 8 | 4 | 0 | 0 | 12 |
| Hepatic dysfunction | 12 | 1 | 0 | 0 | 13, 6.7% |
| Jaundice in the presence of pre-eclampsia | 0 | 0 | 0 | 0 | 0 |
| Bilirubin >100mmol/l or >6.0 mg/dL | 12 | 1 | 0 | 0 | 13 |
| Neurological dysfunction | 6 | 2 | 0 | 0 | 8, 4.2% |
| Loss of consciousness lasting 12 hours (GCS < 10) | 4 | 2 | 0 | 0 | 6 |
| Stroke | 0 | 0 | 0 | 0 | 0 |
| Loss of consciousness and ketoacids in urine | 0 | 0 | 0 | 0 | 0 |
| Uncontrollable fit | 1 | 0 | 0 | 0 | 1 |
| New onset of paralysis | 1 | 0 | 0 | 0 | 1 |
| Uterine dysfunction | 5 | 1 | 0 | 0 | 6, 3.0% |
| Hysterectomy following infection or haemorrhage | 5 | 1 | 0 | 0 | 6 |
| Total | 150 | 30 | 9 | 5 | 194 |
Italics unique SSA criteria and underlined unique WHO criteria. A woman could fulfil more than one MNM criterion. At the top of each section the total number of women with each organ dysfunction, followed by the proportion, calculated by this total divided by 194 MNM women and presented as percentage. MNM, Maternal near miss; SSA, sub-Saharan Africa; WHO, World Health organisation, ICU, intensive care unit; CPR, cardio pulmonary resuscitation; GCS, Glasgow coma scale.
bpresence of fever (Temp >38°C) AND confirmed or suspected infection AND at least one of the following: heart rate >90, respiratory rate >20, WBC > 12 or < 4 x 109/L; ccomplete rupture of uterus during labour confirmed by laparotomy; dseptic incomplete abortion, complicated gestational trophoblastic disease with anaemia; emajor signs of organ dysfunction and/or high level parasitaemia or cerebral malaria; fpersistent systolic blood pressure <80 mmHg or a persistent systolic blood pressure <90 mmHg with a pulse rate at least 120 bpm; gurinary output <30 ml/hour over 4 hours or <400 ml/24 hr.