The World Health Organization (WHO) maternal near-miss criteria^[1]

Clinical criteria	Laboratory-based criteria	Management-based criteria
Acute cyanosis Gasping* Respiratory rate >40 or <6/min Shock^¶ Oliguria nonresponsive to fluids or diuretics^Δ Clotting failure^◊ Loss of consciousness lasting ≥12 hours^§ Loss of consciousness AND absence of pulse/heart beat Stroke^¥ Uncontrollable fit/total paralysis^‡ Jaundice in the presence of preeclampsia^†	Oxygen saturation <90% for ≥60 minutes PaO₂/FiO₂ <200 mmHg Creatinine ≥300 micromol/L or ≥3.5 mg/dL Bilirubin >100 micromol/L or >6.0 mg/dL pH <7.1 Lactate >5 Acute thrombocytopenia (<50,000 platelets) Loss of consciousness AND the presence of glucose and ketoacids in urine	Use of continuous vasoactive drugs** Hysterectomy following infection or hemorrhage Transfusion of ≥5 units red cell transfusion Intubation and ventilation for ≥60 minutes not related to anesthesia Dialysis for acute renal failure CPR

The WHO maternal near-miss criteria: A woman presenting with any of the life-threatening conditions listed in the table and surviving a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy should be considered as a maternal near-miss case.

CPR: cardiopulmonary resuscitation; IV: intravenous.
* Gasping is a terminal respiratory pattern, and the breath is convulsively and audibly caught.
¶ Shock is a persistent severe hypotension, defined as a systolic blood pressure <90 mmHg for ≥60 minutes with a pulse rate of at least 120 despite aggressive fluid replacement (>2 L).
Δ Oliguria is defined as a urinary output <30 mL/hour for 4 hours or <400 mL/24 hours.
◊ Clotting failure can be assessed by the bedside clotting test or absence of clotting from the IV site after 7 to 10 minutes.
§ Loss of consciousness is a profound alteration of mental state that involves complete or near complete lack of responsiveness to external stimuli. It is defined as a Coma Glasgow Scale <10 (moderate or severe coma).
¥ Stroke is a neurologic deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours.
‡ Condition in which the brain is in a state of continuous seizure.
† Preeclampsia is defined as the presence of hypertension associated with proteinuria. Hypertension is defined as a blood pressure of at least 140 mmHg (systolic) or at least 90 mmHg (diastolic) on at least 2 occasions and at least 4 to 6 hours apart after the 20^th week of gestation in women known to be normotensive beforehand. Proteinuria is defined as excretion of 300 mg or more of protein every 24 hours. If 24-hour urine samples are not available, proteinuria is defined as a protein concentration of 300 mg/L or more (≥1+ on dipstick) in at least 2 random urine samples taken at least 4 to 6 hours apart.
** For instance, continuous use of any dose of dopamine, epinephrine, or norepinephrine.

Reference:

Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health 2004; 1:3.

Adapted from: Ganchimeg T, Nagata C, Vogel JP, et al. Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health. PLoS One 2016; 11:e0149091. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149091. Copyright © 2016 The Authors. Reproduced under the terms of the Creative Commons Attribution License 4.0.

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The World Health Organization (WHO) maternal near-miss criteria[1]

The World Health Organization (WHO) maternal near-miss criteria^[1]