Maternal ‘near miss’ at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit

Abstract

BACKGROUND: Assessment of severe maternal morbidity using World Health Organization (WHO) 'near-miss' criteria is gaining in importance as a valuable tool in the assessment of maternity care of women. Identification of cases allows an understanding of aetiology of severe morbidity and factors contributing to poor maternal outcomes. AIM: The aim of this study is to determine the rate of maternal 'near miss' at Royal Darwin Hospital (RDH) and the utility of the WHO near-miss criteria as a tool for data collection in a regional Australian context. METHODS AND MATERIALS: Cases of maternal 'near miss' and deaths were prospectively identified over a period of 12 months using the WHO criteria. RESULTS: During the audit period, there were 2080 live births at Royal Darwin Hospital (RDH): 10 women presented with a 'near miss' and there was one maternal death. The maternal mortality ratio for the hospital was 48/100 000 live births, the maternal 'near-miss' index ratio was 4.8/1000 live births, and the combination of maternal deaths and near misses gave a severe maternal outcome (SMO) ratio of 5.3/1000 live births. The main cause of obstetric 'near miss' was obstetric haemorrhage. Indigenous women and women from remote areas comprised a significant portion of 'near-miss' cases. CONCLUSION: The rates of maternal 'near miss' at RDH are consistent with other studies in the developed world. The WHO maternal 'near-miss' audit tool helps health professionals understand and anticipate severe maternal morbidities, with the aim of improving maternal and perinatal outcomes.