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Table 1 WHO near miss criteria and modifications for Ruhengeri hospital

From: Maternal Near Miss and quality of care in a rural Rwandan hospital

WHO near miss criteria [10]

Ruhengeri near miss criteria

Clinical Criteria

 Acute Cyanosis

Not modified

 Gasping

Not modified

 Respiratory rate > 40 or < 6/min

Not modified

 Shocka

Not modified

 Oliguria non responsive to fluids or diureticsb

Not modified

 Failure to form clotsc

Not modified

 Loss of consciousness lasting > 12 hd

Not modified

 Cardiac arreste

Not modified

 Strokef

Not modified

 Uncontrollable fit/total paralysisg

Not modified

 Jaundice in the presence of pre-eclampsiah

Not modifiedi

Laboratory-based criteria

 Oxygen saturation < 90 % for ≥ 60 min

Not modified

 PaO2/FiO2, 200 mmHg

Not availablej

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

Not modified

 Bilirubin > 100 mmol/l or .6.0 mg/dL

Not modified

 pH < 7.1

Not available

 Lactate > 5 mEq/mL

Not available

 Acute thrombocytopenia (< 50,000 platelets/ml)

Not modified

 ketoacids in urine

Not available

Management-based criteria

 Admission to intensive care unit

Not modified

 Use of continuous vasoactive drugs

Not modified

 Hysterectomy following infection or hemorrhage

Not modified

 Transfusion of ≥ 5 units of blood

Not modified

 Intubation and ventilation for ≥ 60 min not related to anesthesia

Not modified

 Dialysis for acute renal failure

Not available

 Cardio-pulmonary resuscitation

Not modified

Severe maternal complications

 

Eclampsiak

 

Sepsis or severe systemic infectionl

 

Ruptured uterusm

  1. aShock 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)
  2. bOliguria is defined as an urinary output < 30 ml/h for 4 h or < 400 ml/24 h
  3. cFailure to form clots is defined as the absence of clotting from the IV site after 7–10 min
  4. dUnconsciousness/coma lasting > 12 h 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
  5. eCardiac arrest is defined as loss of consciousness and absence of pulse or heart beat
  6. fStroke is defined as a neurological deficit of cerebrovascular cause that persists ≥ 24 h, or is interrupted by death within 24 h
  7. gUncontrollable fit is a condition in which the brain is in state of continuous seizure
  8. hPre-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 h or 300 mg protein/l urine or ≥ 1+ on a dipstick
  9. iWas not regularly available due to lack of resources
  10. jNot available
  11. kEclampsia is defined as the presence of hypertension associated with proteinuria and fits
  12. lSepsis is defined as a clinical sign of infection and 3 of the following: temp > 38C or < 36C, respiration rate > 20/min, pulse rate > 90/min, WBC > 12, clinical signs of peritonitis
  13. mUterine rupture is defined as the complete rupture of a uterus during labor
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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