Table 1.

Definition of potentially life-threatening and life-threatening complications in pregnancy defined by WHO and minor adaptations within the Suriname Obstetric Surveillance System (SurOSS)

Criterion	WHO	SurOSS
Potentially life-threatening complications (PLTC)
Disease-based criteria:
Severe post-partum hemorrhage	Genital bleeding after delivery, with at least one of the following: perceived abnormal bleeding (1000 mL or more) or any bleeding with hypotension or blood transfusion.	• 1000 mL blood loss and/or
		• Any bleeding (antepartum, intrapartum or postpartum) with hypotension or transfusion of at least 3 products
Severe pre-eclampsia	Persistent systolic blood pressure of 160 mm Hg or more or a diastolic blood pressure of 110 mm Hg; proteinuria of 5 g or more in 24 h; oliguria of <400 mL in 24 h; and HELLP syndrome or pulmonary oedema. Excludes eclampsia.	Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 h apart and:
		• Thrombocytopenia (platelet count of <100x9 109/L)
		• Raised plasma ALT or AST (twice the upper limit of normal)
		• Renal insufficiency (doubling of the serum creatinine)
		• Pulmonary edema
		• Pre-eclampsia complaints, not attributed to other causes, such as unresponsive headache, epigastric pain, visual disturbances
Eclampsia	Generalized fits in a patient without previous history of epilepsy. Includes coma in pre-eclampsia.	Seizures in a woman during pregnancy or up to 14 d postpartum, without any other attributable cause, with at least one of the following signs:
		• Hypertension (≥140 mm Hg systolic or ≥90 mm Hg diastolic)
		• Proteinuria [at least 1 g/L [‘2 +’] on dipstick testing]
		• Thrombocytopenia (platelet count of <100x9 109/L)
		• Raised plasma ALT or AST (twice the upper limit of normal)
Severe sepsis	Presence of fever (body temperature >38°C), a confirmed or suspected infection (eg, chorioamnionitis, septic abortion, endometritis, pneumonia), and at least one of the following: heart rate >90, respiratory rate >20, leukopenia (white blood cells <4000), leukocytosis (white blood cells >12 000).	Any pregnant or recently pregnant woman (up to 6 weeks postpartum) diagnosed with severe sepsis (irrespective of the source of infection). Clinical diagnosis of severe sepsis, associated with two or more of the following:
		• Temperature >38C or <36C measured on two occasions at least 4 h apart
		• Heart rate >100 beats/min measured on two occasions at least 4 h apart
		• Respiratory rate >20/min measured on two occasions at least 4 h apart
		• White cell count >17x109/L or <4x109/L or with
		•>10% immature band forms, measured on 2 occasions
Ruptured uterus	Rupture of uterus during labour confirmed by laparotomy.	A visually confirmed, complete rupture of the myometrium and serosa
Severe complications of abortion	Not further defined	Severe hemorrhage (≥1000mL, hypotension, blood transfusion of at least 3 products), severe sepsis or complications due lesion of intestines or other organs or complications related to anesthesia.
Intervention-criteria:
Intensive care unit admission	Not further defined	Admission to a ward where mechanical ventilation and administration of continous vasoactive drugs are possible
Intervention radiology	Not further defined	Not available in Suriname
Laparotomy excluding caesarean section	Not further defined	Excluding uncomplicated laparotomy for ectopic pregnancy when patient remains hemodynamically stable and blood loss is less than 1000 mL and less than three blood products
Use of blood products	Not further defined	Use of at least 3 blood products
		Excluding blood transfusion for anaemia without any other complications
Life-threatening
Organ-dysfunction criteria:
Cardiovascular	Shock, cardiac arrest (absence of pulse/ heart beat and loss of consciousness), use of continuous vasoactive drugs, cardiopulmonary resuscitation, severe hypoperfusion (lactate >5 mmol/L or >45 mg/dL), severe acidosis (pH<7.1)
Respiratory	Acute cyanosis, gasping, severe tachypnea (respiratory rate >40 breaths per minute), severe bradypnea (respiratory rate <6 breaths per minute), intubation and ventilation not related to anesthesia, severe hypoxemia (O2 saturation <90% for ≥60 min or PAO2/FiO2 < 200)
Renal	Oliguria non-responsive to fluids or diuretics, dialysis for acute renal failure, severe acute azotemia (creatinine ≥300 μmol/mL or ≥3.5 mg/dL)
Coagulation / hematological	Failure to form clots, massive transfusion of blood or red cells (≥5 units), severe acute thrombocytopenia (<50 000 platelets/mL)
Hepatic	Jaundice in the presence of pre-eclampsia, severe acute hyperbilirubinemia (bilirubin >100 μmol/L or >6.0 mg/dL)
Neurologic	Prolonged unconsciousness (lasting ≥12 h)/coma (including metabolic coma), stroke, uncontrollable fits/status epilepticus, total paralysis
Uterine dysfunction	Uterine hemorrhage or infection leading to hysterectomy