Table 1

Criteria for inclusion of near miss cases (modified from Mantel et al 1998)

Organ dysfunction

Cardiac dysfunction

Pulmonary oedema, cardiac arrest, cardiac failure

Pulmonary embolism


Vascular dysfunction

Hypovolaemia requiring two or more units of blood, blood loss with hypovolaemic shock (systolic blood pressure < 90 mmHg or undetectable pulse), infusion and/or transfusion of > = 1 litre in 2 hours, free flow infusiona, massive haemorrhage recorded in notes

Immunological dysfunction

Septic shock

Respiratory dysfunction

Intubation or ventilation for reasons other than general anaesthesia, oxygen saturation on pulse oximetry < 90% leading to ventilation

Renal dysfunction

Oliguria < 30 ml per hour or < 400 ml per 24 hours, shock not responsive to intravascular rehydration or diuresis, haemodialysis

Liver dysfunction

Jaundice in pre-eclampsia, abnormal liver function tests

Coagulation dysfunction

Acute thrombocytopenia, prolonged bleeding time, abnormal Activated Partial Thromboplastine Time (APTT) or Prothrombine Time (PT), coagulopathy

Cerebral dysfunction

Coma, cerebral oedema, seizures other than eclampsia

Management based criteria

Intensive care admission, emergency hysterectomy, needs resuscitation, anaesthetic accident, referral to tertiary hospital

Clinical diagnosis

Eclampsia, uterine rupture, ectopic pregnancy

a free flow infusion refers to a massive infusion of fluids in case of shock

Adisasmita et al. BMC Pregnancy and Childbirth 2008 8:10   doi:10.1186/1471-2393-8-10

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