Maternal near miss in three tertiary-level hospitals in Hong Kong
Keywords:Intensive care units, Maternal mortality, Postpartum hemorrhage, Pregnancy complications
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 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.
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