Maternal near miss in three tertiary-level hospitals in Hong Kong

Authors

  • Shu Man Carmen Ng Queen Mary Hospital
  • Po Lam So
  • Wendy Shu
  • Tin Yan Mimi Seto
  • Ka Wang Cheung

DOI:

https://doi.org/10.12809/hkjgom.23.2.337

Keywords:

Intensive care units, Maternal mortality, Postpartum hemorrhage, Pregnancy complications

Abstract

Background: Maternal near miss refers to women who nearly died from a complication during pregnancy. We applied the World Health Organization near miss criteria to determine the incidence and aetiologies of maternal near miss in Hong Kong.
Methods: Medical records of women in three tertiary-level maternity centres in Hong Kong in 2019 who met any of the clinical, laboratory, or management criteria for maternal near miss were retrospectively reviewed. The maternal-near-miss ratio was calculated by the number of maternal-near-miss cases per 1000 livebirths. Women who were admitted to an intensive care unit were compared with women who were not in terms of obstetric characteristics, aetiologies, and organ dysfunctions.
Results: There were 11 075 livebirths in the three hospitals in 2019. 61 maternal-near-miss cases were identified. 29 of these were admitted to an ICU; the median length of stay was 2 days. The maternal-near-miss ratio was 5.51 per 1000 livebirths. The most common cause of maternal near miss was postpartum haemorrhage (52.5%), followed by severe complications of abortion or early pregnancy (24.6%). The most common organ dysfunction was coagulation/haematological dysfunction (45.9%), followed by cardiovascular dysfunction (42.6%), and uterine dysfunction (16.4%). 11.5% of women had more than one organ dysfunction. 73.1% of women with cardiovascular dysfunction did not require ICU admission (p=0.05). Women with uterine dysfunction resulting in a hysterectomy were more likely to be admitted to an ICU (p=0.037). Interventional radiology was more commonly performed on those who were admitted to an ICU than those who were not (24.1% vs 3.1%, p=0.022).
Conclusion: Most maternal-near-miss cases were attributed to postpartum haemorrhage and early pregnancy complications. Early identification and close monitoring are effective in improving maternal healthcare.

References

Cheung KW, Seto MTY, Wang W, Ng CT, To WWK, Ng EHY. Trend and causes of maternal death, stillbirth and neonatal death over seven decades in Hong Kong. Lancet Reg Health West Pac 2022;26:100523.

Cheung KW, Seto MTY, Wang W, et al. Characteristics of maternal mortality missed by vital statistics in Hong Kong, 2000-2019. JAMA Netw Open 2023;6:e230429. DOI: https://doi.org/10.1001/jamanetworkopen.2023.0429

World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: WHO; 2011.

De Silva M, Panisi L, Lindquist A, et al. Severe maternal morbidity in the Asia Pacific: a systematic review and meta-analysis. Lancet Reg Health West Pac 2021;14:100217.

Donati S, Senatore S, Ronconi A; Regional Maternal Mortality Working Group. Obstetric near-miss cases among women admitted to intensive care units in Italy. Acta Obstet Gynecol Scand 2012;91:452-7. DOI: https://doi.org/10.1111/j.1600-0412.2012.01352.x

Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Bréart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006;108:541-8. DOI: https://doi.org/10.1097/01.AOG.0000233154.62729.24

Shander A, Javidroozi M, Sentilhes L. Tranexamic acid and obstetric hemorrhage: give empirically or selectively? Int J Obstet Anesth 2021;48:103206.

Gallos ID, Williams HM, Price MJ, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2018;4:CD011689. DOI: https://doi.org/10.1002/14651858.CD011689.pub2

Maraschini A, Lega I, D’Aloja P, et al. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: a prospective population‐based study. Acta Obstet Gynecol Scand 2019;99:274-82.

Yuk JS, Kim YJ, Hur JY, Shin JH. Association between socioeconomic status and ectopic pregnancy rate in the Republic of Korea. Int J Gynecol Obstet 2013;122:104-7. DOI: https://doi.org/10.1016/j.ijgo.2013.03.015

Downloads

Published

2023-06-05

How to Cite

1.
Ng SMC, So PL, Shu W, Seto TYM, Cheung KW. Maternal near miss in three tertiary-level hospitals in Hong Kong. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Jun. 5 [cited 2024 Apr. 22];23(2). Available from: https://hkjgom.org/home/article/view/337

Issue

Section

Original Article

Most read articles by the same author(s)