Cohort study of near-miss maternal mortality and subsequent reproductive outcome.

OBJECTIVE

To determine the aetiology and outcome of near-miss mortality in obstetrical patients and the subsequent reproductive outcome where fertility is conserved.

STUDY DESIGN

Retrospective cohort study of 51,576 women delivered at a University teaching hospital of whom 50 required transfer for critical care.

RESULTS

Over the 12 year study period 1988-1999, 50 women required transfer for intensive care (0.97/1000) and there were three maternal deaths (5.8/100,000). The main indications for transfer were hypertensive disease (32%), haemorrhage (24%) and maternal cardiac disease (24%). The perinatal mortality rate was 14%. Thirty two women conserved their fertility potential and 16 had subsequent healthy liveborn children.

CONCLUSIONS

This study of near-miss maternal mortality reminds us of the need for continuing vigilance in the provision of obstetrical care. The successful reproductive outcome highlights the resilience of many women to adverse events in pregnancy but the high loss of fertility potential reflects the physical and psychological morbidity incurred.