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British Medical Bulletin 67:231-243 (2003)
© 2003 Oxford University Press

Near misses: a useful adjunct to maternal death enquiries

RC Pattinson* and M Hall{dagger}

* MRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, South Africa and
{dagger} Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK

Correspondence to: RC Pattinson, Department of Obstetrics and Gynaecology, Kalafong Hospital, Private Bag X396, Pretoria 0001, South Africa. E-mail: rcpattin{at}kalafong.up.ac.za

In developed countries where maternal death is rare, the factors surrounding the death are often peculiar to the event and are not generalizable, making analysis of maternal deaths less useful. Near misses are defined as pregnant women with severe life-threatening conditions who nearly die but, with good luck or good care, survive. Incorporation of near misses into maternal death enquiries would strengthen these audits by allowing for more rapid reporting, more robust conclusions, comparisons to be made with maternal deaths, reinforcing lessons learnt, establishing requirements for intensive care and calculating comparative indices. The survival of a pregnant woman is dependent on the disease, her basic health, the health care facilities and personnel of the health care system. The criteria currently used to identify a near miss vary greatly. However, areas with similar health care facilities, medical records and personnel should be able to agree on suitable criteria, making their incorporation into maternal death enquiries feasible.


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