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Table 4 Adapted sub-Saharan Africa MNM tool

From: Adaptation of the WHO maternal near miss tool for use in sub–Saharan Africa: an International Delphi study

WHO maternal near miss criteria sub-Saharan Africa maternal near miss criteria
Clinical criteria
 Acute cyanosis Acute cyanosis a
 Gasping Gasping b
 Respiratory rate >  40 or <6/min Respiratory rate >  40 or <6/min
 Shock Shock c
 Oliguria non responsive to fluids or diuretics Oliguria non responsive to fluids or diuretics d
 Failure to form clots Failure to form clots e
 Loss of consciousness lasting more than 12 h Loss of consciousness lasting more than 12 h f
 Cardiac arrest Cardiac arrest
 Stroke Stroke g
 Uncontrollable fit/total paralysis Uncontrollable fit/total paralysis h
 Jaundice in the presence of pre-eclampsia Jaundice in the presence of pre-eclampsia i
  Eclampsia j
  Uterine rupture k
  Sepsis or severe systemic infection l
  Pulmonary edema m
  Severe abortion complications n
  Severe malaria o
  Severe pre-eclampsia with ICU admission
Laboratory based criteria
 Oxygen saturation < 90% for > 60 min Oxygen saturation < 90% for > 60 min
 PaO2/FiO2 < 200 mmHg  
 Creatinine ≥ 300 μmol/l or ≥ 3.5 mg/dl 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 Loss of consciousness and ketoacids in urine
Management based criteria
 Use of continuous vasoactive drugs  
 Hysterectomy following infection or haemorrhage Hysterectomy following infection or haemorrhage
 Transfusion of ≥ 5 units of blood Transfusion of ≥ 2 units of red blood cells
 Intubation and ventilation for ≥ 60 min not related to anaesthesia Intubation and ventilation for ≥ 60 min not related to anaesthesia
 Dialysis for acute renal failure  
 Cardio-pulmonary resuscitation Cardio-pulmonary resuscitation
  Laparotomy other than caesarean section
  1. aAcute cyanosis is blue or purple colouration of the skin or mucous membranes due to low oxygen saturation
  2. bGasping is a terminal respiratory pattern and the breath is convulsively and audibly caught
  3. cShock is persistent severe hypotension, defined as a systolic BP <90 mmHg for ≥ 60 min with a pulse rate at least 120 despite aggressive fluid replacement (> 2 L)
  4. dOliguria is urinary output <30 ml/h for 4 h or <400 ml/24 h
  5. eFailure to form clots can be assessed by the bedside clotting test or absence of clotting from the IV site after 7–10 min
  6. fLoss of consciousness lasting > 12 h is a profound alteration of mental state that involves complete or near-complete lack of responsiveness to external stimuli. It is defined as a Glasgow Coma Scale <10 (moderate or severe coma)
  7. gStroke is neurological deficit of cerebrovascular cause that persists beyond 24 h or is interrupted by death within 24 h
  8. hUncontrolled fits/total paralysis is refractory, persistent convulsions or status epilepticus
  9. IPre-eclampsia is defined as the presence of hypertension associated with proteinuria. Hypertension is defined as a BP of at least 140/90 mmHg on at least two occasions and at least 4-6 h apart after the 20th week of gestation in women known to be normotensive beforehand. Proteinuria is defined as excretion of 300 mg or more of protein every 24 h. If 24-h urine samples are not available, proteinuria is defined as a protein concentration of 300 mg/l or more (≥ 1 on dipstick) in at least two random urine samples taken at least 4–6 h apart
  10. jEclampsia is diastolic BP ≥ 90 mmHg or proteinuria +3 and convulsion or coma
  11. kUterine rupture is complete rupture of uterus during labour and/or confirmed later by laparotomy
  12. lSepsis or severe systemic infection 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 > 12,000
  13. mPulmonary edema is accumulation of fluids in the air spaces and parenchyma of the lungs
  14. nSevere abortion complications is defined as septic incomplete abortion, or complicated gestational trophoblastic disease with anaemia
  15. oSevere malaria is defined as major signs of organ dysfunction and/or high level parasitemia or cerebral malaria
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BMC Pregnancy and Childbirth

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