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

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 9(th) 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.