Table 2 Criteria and definitions of severe maternal morbidity

1

Major obstetric haemorrhage

Estimated blood loss ≥ 2500ml, or transfused 5 or more units of blood or received treatment for coagulopathy

2

Eclampsia

Seizure associated with antepartum, intrapartum or postpartum symptoms and signs of pre-eclampsia.

3

Renal or liver dysfunction

Acute onset of biochemical disturbance, urea > 15mmol/l, creatinine > 400mmol/l, AST/ALT > 200u/l.

4

Cardiac arrest

No detectable major pulse.

5

Pulmonary oedema

Clinically diagnosed pulmonary oedema associated with acute breathlessness and O₂ saturation < 95%, requiring O₂, diuretics or ventilation.

6

Acute respiratory dysfunction Requiring intubation or ventilation for > 60 minutes (not including duration of general anaesthetic).

7

Coma Including diabetic coma. Unconscious for > 12 hours.

8

Cerebro-vascular event

Stroke, cerebral/cerebellar haemorrhage or infarction, subarachnoid haemorrhage, dural venous sinus thrombosis.

9

Status epilepticus

Unremitting seizures in patient with known epilepsy.

10

Anaphylactic shock

An allergic reaction resulting in collapse with severe hypotension, difficulty breathing and swelling/rash.

11

Septicaemic shock

Shock (systolic blood pressure < 80 mm/Hg) in association with infection. No other cause for decreased blood pressure. Pulse of 120 beats/minute or more.

12

Anaesthetic problem

Aspiration, failed intubation, high spinal or epidural anaesthetic.

13

Massive pulmonary embolism

Increased respiratory rate (> 20/min), tachycardia, hypotension. Diagnosed as ‘high’ probability on V/Q scan or positive spiral chest CT scan. Treated by heparin, thrombolysis or embolectomy.

14

Intensive care admission/ Coronary care admission

Unit equipped to ventilate adults. Admission for one of the above problems or for any other reason. Include CCU admissions.

Waterstone et al’s criteria and definition [[18]]

1

Severe pre­eclampsia

Blood pressure 170/110 mm Hg on two occasions 4 hours apart or > 170/110 mm Hg once plus ≥ 0.3 g in 24 hours proteinuria or ≥ + + on dipstick

OR

Diastolic blood pressure > 90 mm Hg plus proteinuria (as above) on one occasion plus one of the following signs/symptoms: Oliguria (< 30 ml/h for 2 hours), Visual disturbances (flashing lights or blurred vision), Epigastric/right upper quadrant pain or tenderness, Thrombocytopenia (< 100x10⁹/l) Pulmonary oedema

2

Eclampsia

Convulsions during pregnancy or in the first 10 days postpartum together with at least two of the following features within 24 hours after the convulsions: Hypertension (≥ 170/110 mm Hg), Proteinuria (≥ + on random dipstick analysis or ≥ 0.3 g in 24 hours)

Thrombocytopenia (< 100x10⁹/l), Increased aspartate aminotransferase (≥ 42 U/l)

3

HELLP syndrome

Haemolysis (abnormal peripheral smear or raised total bilirubin concentration (≥ 20.5 μmol/l)), raised liver enzyme activity (raised aspartate aminotransferase (≥ 70 U/l) or raised γ­glutamyltransferase (≥ 70 U/l), and low platelets (< 100x10⁹/l))

4

Severe haemorrhage

Estimated blood loss > 1500 ml, peripartum fall in haemoglobin concentration ≥ 40 g/l or acute transfusion of 4 or more units of blood

5

Severe sepsis

Sepsis is systemic response to infection manifested by two or more of: Temperature > 38°C or < 36°C (unless after prolonged caesarean), Heart rate > 100 beats/minute, Respiratory rate > 20/min or PaCO₂ < 32 mmHg, White cell count > 17x10⁹/l or < 4x10⁹/l or > 10% immature forms, Plus bacteraemia (that is, positive blood cultures) or positive swab culture

Severe sepsis is sepsis associated with one of: Organ dysfunction—for example, acute renal failure, Hypoperfusion—for example, lactic acidosis, oliguria, or acute alteration in mental state, Hypotension—that is, systolic blood pressure < 90 mm Hg or drop of > 40 mm Hg in the absence of other causes of hypotension

6

Uterine rupture

Acute dehiscence of the uterus leading to the emergency delivery of the infant