Maternal near miss: The crown of death in obstetrics

Aim: Maternal near-miss is defined as a woman who survives a life-threatening condition during pregnancy, delivery, or postpartum period. Assessing near-miss cases offers a critical opportunity to apply standardized care before a fatal outcome occurs. However, there is currently no centralized database for near-miss cases in Turkey. The present study aimed to estimate the incidence and causes of near-miss cases at a tertiary hospital setting in Turkey. Methods: This retrospective observational study was carried out at a university-affiliated research and training hospital between January 2019 and December 2022. A total of 150 maternal near-miss cases and 4 maternal deaths were analyzed. Demographic, obstetrics and laboratory characteristics were presented. Results: The near miss ratio was 4.25 per 1,000 live births, while the maternal mortality ratio was 11.34 per 100,000 live births. It was found that 38% of patients in the maternal near-miss group had received regular prenatal care and 20% of the near-miss cases were referred to our center after delivering in an external hospital. Hypertensive disorders of pregnancy accounted for 40% of near-miss cases, while hemorrhagic conditions comprised 38%. Placental abruption and obstetric-related disseminated intravascular coagulation made up 12.6% of all cases, and other systemic diseases accounted for 9.3%. Conclusion: Similar to maternal mortality, hypertensive disorders and hemorrhagic conditions were the leading causes of near-miss events. However, given the higher incidence of near-miss cases compared to maternal deaths, we suggest that identifying near-miss events could play a crucial role in preventing maternal mortality.