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Obstetric near-miss cases among women admitted to intensive care units in Italy

Authors

  • SERENA DONATI,

    1. National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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  • SABRINA SENATORE,

    1. National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
    2. University – Tor Vergata, Rome, Italy
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  • ALESSANDRA RONCONI,

    1. National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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  • the Regional Maternal Mortality Working Group

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    • Vittorio Basevi, Veronica Casotto, Achille Cernigliaro, Gabriella Dardanoni, Martina De Nisi, Domenico Di Lallo, Valeria Dubini, Camilla Lupi, Luisa Mondo, Silvano Piffer, Renato Pizzuti, Arianna Polo, Raffaella Rusciani, Michele Santoro, Maurizio Saporito, Daniela Spettoli, Eleonora Verdini.


  • Please cite this article as: Donati S, Senatore S, Ronconi A & the Regional Maternal Mortality Working Group. Obstetric near-miss cases among women admitted to intensive care units in Italy. Acta Obstet Gynecol Scand 2012; 91: DOI: 10.1111/j.1600-0412.2012.01352.x.

Serena Donati, National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, via Giano della Bella 34, 00162 Rome, Italy. E-mail: serena.donati@iss.it

Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Abstract 

Objective. Maternal near-miss defines a narrow category of morbidity encompassing potentially life-threatening episodes. The purpose of this study was to detect near-miss instances among women admitted to intensive care units or coronary units, analyze associated causes, and compute absolute and specific maternal morbidity rates in six Italian regions. Design. Observational retrospective study. Setting. Six Italian regions representing 49% of all resident Italian women aged 15–49 years. Population. The study population included all pregnant women aged 15–49 years admitted to intensive care units or coronary care units in the participating regions. Cases were defined as women aged 15–49 years resident in the participating regions, with one or more hospitalizations in intensive care for pregnancy or any pregnancy outcome between 2004 and 2005. Methods. Cases were identified through the Hospital Discharge Database. Enrolled cases were diagnosed according to the 9th International Classification of Diseases. Main outcome measure. Maternal near-miss rate (number of women experiencing an admission to intensive care units/all women with live or stillborn babies). Results. A total of 1259 near-miss cases were identified and the total maternal near-miss rate was 2.0/1000 deliveries. Seventy percent of the women were admitted to intensive care units or coronary units after a cesarean section. The leading associated risk factors were obstetric hemorrhage/disseminated intravascular coagulation (40%) and hypertensive disorders of pregnancy (29%). Conclusions. Monitoring of near-miss morbidity in conjunction with mortality surveillance could help to identify effective preventive measures for potentially life-threatening episodes.

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