Maternal 'near miss' at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit.
BACKGROUND
Assessment of severe maternal morbidity using World Health Organization (WHO) 'near-miss' criteria is gaining in importance as a valuable tool in the assessment of maternity care of women. Identification of cases allows an understanding of aetiology of severe morbidity and factors contributing to poor maternal outcomes.


AIM
The aim of this study is to determine the rate of maternal 'near miss' at Royal Darwin Hospital (RDH) and the utility of the WHO near-miss criteria as a tool for data collection in a regional Australian context.


METHODS AND MATERIALS
Cases of maternal 'near miss' and deaths were prospectively identified over a period of 12 months using the WHO criteria.


RESULTS
During the audit period, there were 2080 live births at Royal Darwin Hospital (RDH): 10 women presented with a 'near miss' and there was one maternal death. The maternal mortality ratio for the hospital was 48/100 000 live births, the maternal 'near-miss' index ratio was 4.8/1000 live births, and the combination of maternal deaths and near misses gave a severe maternal outcome (SMO) ratio of 5.3/1000 live births. The main cause of obstetric 'near miss' was obstetric haemorrhage. Indigenous women and women from remote areas comprised a significant portion of 'near-miss' cases.


CONCLUSION
The rates of maternal 'near miss' at RDH are consistent with other studies in the developed world. The WHO maternal 'near-miss' audit tool helps health professionals understand and anticipate severe maternal morbidities, with the aim of improving maternal and perinatal outcomes.
['Jayaratnam|Skandarupan|S|', 'Burton|Alice|A|', 'Connan|Kirsten Fiona|KF|', 'de Costa|Caroline|C|']
D005260:Female D006757:Hospital Units D006801:Humans D008428:Maternal Mortality D008485:Medical Audit D000067491:Near Miss, Healthcare D015876:Northern Territory D011247:Pregnancy D011248:Pregnancy Complications D011446:Prospective Studies D019984:Quality Indicators, Health Care D062606:Tertiary Care Centers D014592:Uterine Hemorrhage D014944:World Health Organization
maternal morbidity indigenous pregnancy