“Near miss” in obstetrics: classification, evaluation, and significance for healthcare technology assessment

Abstract

To reduce maternal mortality, it is important to analyze the clinical conditions posing a potential threat to pregnant women. To characterize such states, the definition was introduced – “maternal morbidity, which almost took the woman’s life” (the near miss maternal morbidity), or the “near miss”. The “near miss” criteria were first defined in 2009. This review article provides a rationale for auditing the “near miss” cases for the purposes of healthcare technologies asessment. The paper also discusses the clinical and economic aspects of “near miss” analysis and the methodology for assessing the “near miss” incidence. Also of scientific and practical interest is the classification of maternal “near miss” cases developed by our colleagues from theRostovPerinatalCenter. Thus, maternal “near miss” cases are divided into obstetric (emergency), extragenital, planned (managed), organizational, and iatrogenic. This differentiated approach to the maternal critical conditions allows us to understand not only their causes, but also to develop a plan of further actions for each specific group. This contributes to the development of rehabilitation and prevention measures to be taken during subsequent pregnancies.

Keywords

• maternal mortality
• “near miss”
• health technology assessment
• “near miss” classification
• preeclampsia
• eclampsia
• miscarriage