Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss

Show simple item record Cecatti, Jose G. Souza, Joao P. Neto, Antonio F. Oliveira Parpinelli, Mary A. Sousa, Maria H. Say, Lale Pattinson, Robert Clive 2012-05-25T11:51:50Z 2012-05-25T11:51:50Z 2011-08
dc.description.abstract BACKGROUND: To evaluate the performance of the WHO criteria for defining maternal near miss and identifying deaths among cases of severe maternal morbidity (SMM) admitted for intensive care. METHOD: Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18 died. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score were retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die defined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each one of the six components of the score, being considered the gold standard for the diagnosis of maternal near miss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum SOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting maternal death and also for identifying cases of organ failure were estimated. RESULTS: The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent criteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (≥1 h). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of the 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near miss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with no failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve of 0.897) for prediction of cases of maternal near miss according to the WHO criteria. CONCLUSIONS: The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost all cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently enable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers. en_US
dc.description.sponsorship The State of São Paulo Research (FAPESP), SP, Brazil. Grant number 2007/000290-8. en_US
dc.description.uri en_US
dc.identifier.citation Cecatti, JG, Souza, JP, Neto, AFO, Parpinelli, MA, Sousa, MH, Say, L & Pattinson, RC 2011, 'Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss', Reproductive Health, vol. 8, no. 22, pp. 1-7. en_US
dc.identifier.issn 1742-4755 (print)
dc.identifier.other 10.1186/1742-4755-8-22
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights © 2011 Cecatti et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.subject Severe maternal morbidity (SMM) en_US
dc.subject WHO criteria en_US
dc.subject Maternal near miss en_US
dc.title Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss en_US
dc.type Article en_US

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