severe maternal morbidity and near misses in two tertiary referral hospitals in iran

Background: investigating severe maternal morbidity/near miss is a newly recognized tool which identifies women at the highest risk of maternal death and helps allocate resources, especially in developing countries.objectives: this study aimed to document the prevalence and causes of severe maternal morbidity (smm) at two educational hospitals in ahvaz, khuzestan, iran.patients and methods: in this prospective study, we found and selected smm patients based on organ failure criteria from patients admitted in two educational hospitals of ahvaz jundishapur university of medical sciences during 2009 - 2010. until recovery discharge or death, the diagnosis and management of these patients were under observation of obstetricians. the main outcome was maternal mortality ratio, smm rate (smmr).results: totally, there were 12,149 deliveries, eight maternal deaths and 226 smm cases. this study showed the smmr of 18.6/1000 live births, an mmr of 65.8/100000 live births, and case fatality ratio of 1/28 or 3.5%. severe preeclampsia and hemolysis elevated liver enzymes low platelet count syndrome (hellp) (38%), hemorrhage (23%) and ectopic pregnancy (14%) were the top causes of smm. similar to hellp syndrome (25%) hemorrhage (25%), sepsis (25%) was the commonest cause of mortality; 39% of patients were referred from primary or secondary health care units; 85% of the cases needed intensive care unit admissions.conclusions: smm analysis provides valuable information on obstetric care. this study highlighted the need to improve antenatal care, which would help early identification of high-risk pregnancies. every smm could progress to maternal mortality if is not suspected, diagnosed and managed on its golden time.