Introduction: As the absolute numbers of maternal deaths in an institution are few, maternal death audits may not provide the true picture of service provision. Therefore severe acute maternal morbidity (SAMM), also referred to as near misses, has been proposed as a supplementary indicator for the assessment of the quality of maternity care.

Objective: To study SAMM in order to identify strategies which could be adopted to improve quality of care.

Design, Setting and Methods: Using the WHO near-miss criteria, a clinical audit was carried out in all five consultant units of the Castle Street Hospital for Women (CSHW), Colombo from 1st February 2011 to 31st January 2012. Of the admissions to the intensive care, only those who conformed to the WHO near-miss inclusion criteria were studied.

Results: There were 91 cases of SAMM and five maternal deaths out of 16511 live births, giving a maternal mortality ratio of 30.3/100,000 live births, a maternal near-miss ratio of 5.5/1000 live births and a maternal near miss: mortality ratio of 18.2. Of the 91 cases of SAMM, there were 35 (38.5%) cases of major post partum hemorrhage (PPH), 18 (19.8%) cases of thrombocytopenia and coagulopathy due to Dengue fever, nine (9.9%) cases with cardiac dysfunction, five (5.5%) cases of liver disease and six (6.6%) cases of eclampsia. There were 45 cases who had more than one inclusion criterion. Suboptimal management processes identified included incomplete documentation in some cases, non documentation of estimated blood loss in PPH, deficiencies in monitoring in labor and instrumental delivery, non use of uterine tamponade prior to proceeding to hysterectomy, and inadequate knowledge and experience of uterine tamponade insertion. Conclusions: SAMM is approximately 18 times greater than maternal deaths in the CSHW and approximately 39% of SAMM is due to major PPH. Dengue fever is an important course of SAMM in the CSHW. Appropriate steps should be adopted to correct the sub optimal practices identified. DOI: http://dx.doi.org/10.4038/sljog.v34i4.5930 Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34: 135-143

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