Near-miss maternal mortality in North Greece during the past decade

Introduction

The aim of this study was to determine the level of 'near-miss maternal mortality', due to severe obstetrical complications or maternal disease, in the largest public hospital of Greece. The objective was also to identify risk factors and outcome of pregnant women who required intensive care.

Methods

During the period 1990–2001 (12 years), all pregnant patients who were transferred from the Department of Obstetrics to the ICU of 'Hippokration' General Hospital of Thessaloniki, were retrospectively included into the study. A 'near-miss' describes a patient with an acute organ system dysfunction that, if not treated appropriately, could result in death. The cases fitting this definition and all maternal deaths were analysed. Several factors were looked for and noted: a) the demographic characteristics of the patients, b) the diagnosis at admission in the obstetric unit, c) the indications for admission in the ICU, d) the type of surgery, e) the consultation of other specialities in the management of the critically ill, f) the time of hospitalization, and g) the outcome.

Results

Over 12 years there were 43,754 deliveries in a general hospital with four university obstetric clinics, which covers the area of North Greece with a population of nearly 3 million habitants. One hundred and twenty-two women required transfer for critical care in the ICU (0.28%); of these, 21% had no medical insurance and were immigrants. Mean age was 29.1 years. The main causes of admission in ICU were respiratory insufficiency (32.8%), hypovolemic shock due to hemorrhage (27.1%), hypertension (26.3%), and sepsis (7.4%). Mean time of hospitalization in the ICU was 4.9 days. Several complications, such as DIC, ARDS, acute renal failure, cerebral hemorrhage, and cardiac dysfunction, needed the contribution of other specialities. The majority required ventilatory support, vasoactive drugs and blood transfusions. There were 12 deaths (mortality rate 9.8%).

Conclusions

The term 'near-miss mortality' implicates the potentially mortal complications of pregnancy that needed admission in the ICU. In our study it is 0.28%, and it shows the risks of pregnancy nowadays and indicates the quality of the obstetric care in our country.