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Table 3 Inclusion criteria of SMO used in the three study populations

From: Validating the WHO maternal near miss tool: comparing high- and low-resource settings

The Netherlands Tanzania Malawi
ICU admissionAdmission to an ICU or coronary care unit, other than postoperative recovery Clinical criteriaAcute cyanosis, gasping, respiratory rate > 40 or <6/min, shock, oliguria non responsive to fluids or diuretics, failure to form clots, loss of consciousness lasting >12H, cardiac arrest, stroke, uncontrollable fit/total paralysis, jaundice in the presence of pre-eclampsia Uterine ruptureClinical symptoms or intrauterine foetal death that led to laparotomy, at which diagnosis was confirmed, laparotomy for uterine rupture after vaginal birth, rupture confirmed by autopsy or clinical symptoms with high suspicion of rupture after death
Uterine rupture Clinical symptoms that led to an emergency caesarean section, where uterine rupture was confirmed Peripartum hysterectomy or laparotomy for uterine rupture Laboratory-based criteriaOxygen saturation < 90% for ≥60 minAcute thrombocytopenia (< 50,000 platelets/ml) Eclampsia or severe pre-eclampsia with a maternal indication for termination of pregnancy
Eclampsia/HELLPHELLP syndrome only when accompanied by liver haematoma or rupture Management-based criteria Admission to an ICU, hysterectomy following infection or haemorrhage, transfusion of ≥1 unit of blood, intubation and ventilation ≥60 min not related to anaesthesia, cardio-pulmonary resuscitation Major obstetric haemorrhage(including from complicated abortions and ectopic pregnancies)Transfusion of units of ≥450 ml of blood or a haemoglobin level < 6 g/dl measured after vaginal bleeding or estimated blood loss of >1 l
Major obstetric haemorrhage (MOH)Transfusion of ≥4 units of packed cellsEmbolization or hysterectomy for MOH Severe maternal complicationsEclampsia, sepsis or severe systemic infection, uterine rupture Severe obstetric and non-obstetric peripartum infectionsAll infections for which iv antibiotics or iv anti-malarials were prescribed or surgical treatment was performed. Neoplasms resulting primarily from HIV-infections
MiscellaneousSMO cases to the opinion of the treating obstetrician, not to be included in group 1-4   Other complication ≥2 senior clinicians considered the condition as severe
  1. ICU intensive care unit, HELLP haemolysis elevated liver enzymes and low platelets, SMO severe maternal outcome