Validating the WHO Maternal Near Miss Tool in a high‐income country

This study was performed to assess the applicability of the WHO Maternal Near Miss Tool (MNM Tool) and the organ dysfunction criteria in a high‐income country. Material and methods The MNM tool was applied to 2552 women who died of pregnancy‐related causes or sustained severe acute maternal morbidity between August 2004 and August 2006 in one of the 98 hospitals with a maternity unit in the Netherlands. Fourteen (0.6%) cases had insufficient data for application. Each case was assessed according to the three main “ MNM categories” specified in the MNM tool and their subcategory criteria: five disease‐, four intervention‐ and seven organ dysfunction‐based criteria. Potentially life‐threatening conditions (disease‐based inclusions) and life‐threatening cases (organ dysfunction‐based inclusions) were differentiated according to WHO methodology. Outcomes were incidence of all (sub)categories and case‐fatality rates. Results Of the 2538 cases, 2308 (90.9%) women fulfilled disease‐based, 2116 (83.4%) intervention‐based and 1024 (40.3%) organ dysfunction‐based criteria. Maternal death occurred in 48 women, of whom 23 (47.9%) fulfilled disease‐based, 33 (68.8%) intervention‐based and 31 (64.6%) organ dysfunction‐based criteria. Case‐fatality rates were 23/2308 (1.0%) for cases fulfilling the disease‐based criteria, 33/2116 (1.6%) for intervention‐based criteria and 31/1024 (3.0%) for women fulfilling the organ dysfunction‐based criteria. Conclusions In the Netherlands, where advanced laboratory and clinical monitoring are available, organ dysfunction‐based criteria of the MNM tool failed to identify nearly two‐thirds of sustained severe acute maternal morbidity cases and more than one‐third of maternal deaths. Disease‐based criteria remain important, and using only organ dysfunction‐based criteria would lead to underestimating severe acute maternal morbidity.