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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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