Background: To evaluate the performance of the WHO criteria for defining maternal near miss and identifying\r\ndeaths among cases of severe maternal morbidity (SMM) admitted for intensive care.\r\nMethod: Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18\r\ndied. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score\r\nwere retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die\r\ndefined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each\r\none of the six components of the score, being considered the gold standard for the diagnosis of maternal near\r\nmiss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum\r\nSOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting\r\nmaternal death and also for identifying cases of organ failure were estimated.\r\nResults: The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent\r\ncriteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (=1\r\nh). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of\r\nthe 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near\r\nmiss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with\r\nno failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve\r\nof 0.897) for prediction of cases of maternal near miss according to the WHO criteria.\r\nConclusions: The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost\r\nall cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently\r\nenable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers.
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