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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