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Multicenter Study
. 2025 Jan;168(1):155-166.
doi: 10.1002/ijgo.15818. Epub 2024 Aug 2.

Development of a new definition of maternal near miss based on organ dysfunction in Latin America and the Caribbean: A prospective multicenter cohort study

Jose Rojas-Suarez  1   2 , Jose Santacruz  1   3 , Yasaira Pajaro  1 , Fabian Maza  1 , Bremen de Mucio  4 , Claudio Sosa  4 , Suzanne Serruya  4 , Mario Pérez  5 , Sandra Contreras  1 , Walter Annicchiarico  1   6 , Carmelo Dueñas Castell  1 , Francisco Salcedo  1   6 , Rogelio Rafael Méndez  1   6 , María Escobar-Vidarte  7 , Carlos López  8 , Oscar Lavalle  9 , Winston Mendoza  10 , Carlos Ochoa  11 , Amanda Moreno  12 , Erika Saint-Hillaire  13 , Rigoberto Castro  14 , Hernán Gómez  7 , Evelyn Peña  7 , Lucia Urroz  5 , Violeta Quintela  5 , Mercedes Colomar  15 , Angel Paternina  16
Affiliations
Multicenter Study

Development of a new definition of maternal near miss based on organ dysfunction in Latin America and the Caribbean: A prospective multicenter cohort study

Jose Rojas-Suarez et al. Int J Gynaecol Obstet. 2025 Jan.

Abstract

Background: There has been debate over whether the existing World Health Organization (WHO) criteria accurately represent the severity of maternal near misses.

Objective: This study assessed the diagnostic accuracy of two WHO clinical and laboratory organ dysfunction markers for determining the best cutoff values in a Latin American setting.

Methods: A prospective multicenter cohort study was conducted in five Latin American countries. Patients with severe maternal complications were followed up from admission to discharge. Organ dysfunction was determined using clinical and laboratory data, and participants were classified according to severe maternal outcomes. This study compares the diagnostic criteria of Latin American Centre for Perinatology, Network for Adverse Maternal Outcomes (CLAP/NAMO) to WHO standards.

Results: Of the 698 women studied, 15.2% had severe maternal outcomes. Most measured variables showed significant differences between individuals with and without severe outcomes (all P-values <0.05). Alternative cutoff values suggested by CLAP/NAMOs include pH ≤7.40, lactate ≥2.3 mmol/L, respiratory rate ≥ 24 bpm, oxygen saturation ≤ 96%, PaO2/FiO2 ≤ 342 mmHg, platelet count ≤189 × 109 × mm3, serum creatinine ≥0.8 mg/dL, and total bilirubin ≥0.67 mg/dL. No significant differences were found when comparing the diagnostic performance of the CLAP/NAMO criteria to that of the WHO standards.

Conclusion: The CLAP/NAMO values were comparable to the WHO maternal near-miss criteria, indicating that the WHO standards might not be superior in this population. These findings suggest that maternal near-miss thresholds can be adapted regionally, improving the identification and management of severe maternal complications in Latin America.

Keywords: Latin America; World Health Organization; clinical prediction rule; maternal mortality; maternal near miss.

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References

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