Skip to main content

Table 1 WHO near miss criteria adapted to the local context of HLH (reproduced from Nelissen et al.)

From: Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study

WHO near miss criteria

Haydom near miss criteria

Clinical criteria

Acute cyanosis

Acute cyanosis

Gasping

Gasping

Respiratory rate > 40 or < 6/min

Respiratory rate > 40 or < 6/min

Shock

Shock a

Oliguria non responsive to fluids or diuretics

Oliguria non responsive to fluids or diuretics b

Failure to form clots

Failure to form clots c

Loss of consciousness lasting > 12 h

Loss of consciousness lasting > 12 h d

Cardiac arrest

Cardiac arrest e

Stroke

Stroke f

Uncontrollable fit/total paralysis

Uncontrollable fit/total paralysis g

Jaundice in the presence of pre-eclampsia

Jaundice in the presence of pre-eclampsia h

Laboratory-based criteria

Oxygen saturation < 90% for ≥ 60 minutes

Oxygen saturation < 90% for ≥ 60 minutes

PaO2/FiO2 < 200 mmHg

 

Creatinine ≥ 300 μmol/l or ≥ 3.5 mg/dL

 

Bilirubin > 100 μmol/l or > 6.0 mg/dL

 

pH < 7.1

 

Lactate > 5 mEq/mL

 

Acute thrombocytopenia (< 50,000 platelets/ml)

Acute thrombocytopenia (< 50,000 platelets/ml)

Loss of consciousness and ketoacids in urine

 

Management-based criteria

 

Admission to intensive care unit

Use of continuous vasoactive drugs

 

Hysterectomy following infection or haemorrhage

Hysterectomy following infection or haemorrhage

Transfusion of ≥ 5 units of blood

Transfusion of ≥ 1 unit of blood

Intubation and ventilation for ≥ 60 minutes not related to anaesthesia

Intubation and ventilation for ≥ 60 minutes not related to anaesthesia

Dialysis for acute renal failure

 

Cardio-pulmonary resuscitation

Cardio-pulmonary resuscitation

Severe maternal complications

 

Eclampsia i

 

Sepsis or severe systemic infection j

 

Uterine rupture k

  1. Applicability of the WHO near miss criteria in a low resource setting. PLoS One 2013, 8:e61248.
  2. a: Shock is defined as a persistent severe hypotension, defined as a systolic blood pressure < 90 mmHg for 60 min with a pulse rate of ≥ 120/min despite aggressive fluid replacement (> 2 L).
  3. b: Oliguria is defined as an urinary output < 30 ml/hour for 4 hours or < 400 ml/24 hr.
  4. c: Failure to form clots is defined as the absence of clotting from the IV site after 7–10 minutes.
  5. d: Unconsciousness/coma lasting > 12 hours is defined as a profound alteration of mental state that involves complete or near-complete lack of responsiveness to external stimuli or Glasgow Coma Scale < 10.
  6. e: Cardiac arrest is defined as loss of consciousness and absence of pulse or heart beat.
  7. f: Stroke is defined as a neurological deficit of cerebrovascular cause that persists ≥ 24 hours, or is interrupted by death within 24 hours.
  8. g: Uncontrollable fit is a condition in which the brain is in state of continuous seizure.
  9. h: Pre-eclampsia: the presence of hypertension associated with proteinuria. Hypertension is defined as a blood pressure ≥ 140 mmHg (systolic) or ≥ 90 mmHg (diastolic). Proteinuria is defined as excretion of ≥ 300 mg protein/24 hr or 300 mg protein/litre urine or ≥ 1+ on a dipstick.
  10. i: Eclampsia is defined as the presence of hypertension associated with proteinuria and fits. Hypertension is defined as a blood pressure ≥ 140 mmHg (systolic) or ≥ 90 mmHg (diastolic). Proteinuria is defined as excretion of ≥ 300 mg protein/24 hr or 300 mg protein/litre urine or ≥ 1+ on a dipstick.
  11. j: Sepsis is defined as a clinical sign of infection and 3 of the following: temp > 38°C or < 36°C, respiration rate > 20/min, pulse rate > 90/min, WBC >12.
  12. k: Uterine rupture is defined as the complete rupture of a uterus (including peritoneum) with (partial) extrusion of the fetus during labour.
Back to article page

BMC Pregnancy and Childbirth

ISSN: 1471-2393

Contact us