The paradox of obstetric "near misses": converting maternal mortality into morbidity

OBJECTIVE: To systematically review evidence of obstetric near-misses and their consequences. DATA SOURCES: PUBMED, OVID, and references of retrieved articles were used. METHODS OF STUDY SELECTION: Only 13 original articles describe the occurrence of obstetric/maternal near-miss morbidity to date. All were included in this review, in addition to other articles related to the epidemiology and consequences of severe acute maternal morbidity. TABULATION, INTEGRATION, AND RESULTS: Serious forms of maternal morbidity occur in about 1% of women in the United States compared to 3.01 to 9.05% in some developing settings. Worldwide, the leading causes of near-miss morbidity are hemorrhage and pregnancy-related hypertension or eclampsia/pre-eclampsia. These complications can have lasting effects, and their sequelae may result in maternal illness, injury and disability. Based on severity, we have provided three phenotypes of obstetric near-misses: Class I (near-miss with healthy infant); Class II (near-miss with feto-infant morbidity); Class III (near-miss with fetal/infant death). CONCLUSION: Obstetric near-misses should be considered as potentially chronic illnesses that warrant follow-up care because the theoretical cycle of near-miss (as postulated in this paper) can only be interrupted by the resolution of residual issues or the mother's death. Some may consider near-miss events to be obstetric successes because ultimately the mother's life was spared, but the consequences of these complications can be overwhelming and enduring.