severe maternal morbidity and near misses in two tertiary referral hospitals in iran

conclusions smm analysis provides valuable information on obstetric care. this study highlighted the need to improve antenatal care, which would help early identification of high-risk pregnancies. every smm could progress to maternal mortality if is not suspected, diagnosed and managed on its golden time. background investigating severe maternal morbidity/near miss is a newly recognized tool which identifies women at the highest risk of maternal death and helps allocate resources, especially in developing countries. objectives this study aimed to document the prevalence and causes of severe maternal morbidity (smm) at two educational hospitals in ahvaz, khuzestan, iran. patients and methods in this prospective study, we found and selected smm patients based on organ failure criteria from patients admitted in two educational hospitals of ahvaz jundishapur university of medical sciences during 2009 - 2010. until recovery discharge or death, the diagnosis and management of these patients were under observation of obstetricians. the main outcome was maternal mortality ratio, smm rate (smmr). results totally, there were 12,149 deliveries, eight maternal deaths and 226 smm cases. this study showed the smmr of 18.6/1000 live births, an mmr of 65.8/100000 live births, and case fatality ratio of 1/28 or 3.5%. severe preeclampsia and hemolysis elevated liver enzymes low platelet count syndrome (hellp) (38%), hemorrhage (23%) and ectopic pregnancy (14%) were the top causes of smm. similar to hellp syndrome (25%) hemorrhage (25%), sepsis (25%) was the commonest cause of mortality; 39% of patients were referred from primary or secondary health care units; 85% of the cases needed intensive care unit admissions.