A Look at Near-Miss Mortality and Morbidity in Pregnancy

Previous research suggests that timely delivery of appropriate healthcare services may prevent almost half of all pregnancy-related deaths in the United States. Although maternal deaths are increasingly attributed to preexisting condi­tions, the relative effect of these conditions and the extent to which maternal morbidity and mortality are concentrated in high-risk patients have not been well defined. Focusing on Near-Miss Pregnancy Events Jill M. Mhyre, MD, and colleagues had a study published in the November 2011 issue of Anesthesiology that sought to iden­tify which preexisting conditions predicted maternal morbidity, mortality, and “near- miss” events. A near miss occurs when preg­nant women or recently postpartum women survive a life-threatening event, either because of high-quality medical care or by chance alone. “In our study, we investigated women who died as well as those who sur­vived an event in the hopes of uncovering important lessons with regard to predicting outcomes and preventing progression from near misses to death,” says Dr. Mhyre. A near miss was defined as end-organ injury that impacted hospital discharge. The highest rates of near-miss morbidity or mortality events were found among women with pulmonary hypertension (PH), malig­nancy, and systemic lupus erythematosus (Table). Advancing maternal age and non-white race also increased risk for near-miss morbidity or mortality. “While the effect sizes we observed for age and race were relatively modest when compared with certain medical conditions, these effects remained statistically significant even after controlling for all other medical and obstet­ric conditions,” Dr. Mhyre says. “The abso­lute rate per thousand deliveries increased three-fold when age older than 40 was com­pared with ages 20 to 34, but the adjusted odds ratio was...