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Near-Miss Maternal Mortality: Cardiac Dysfunction as the Principal Cause of Obstetric Intensive Care Unit Admissions

Small, Maria J. MD, MPH; James, Andra H. MD, MPH; Kershaw, Trace PhD; Thames, Betty BS; Gunatilake, Ravi MD; Brown, Haywood MD

doi: 10.1097/AOG.0b013e31824265c7
Original Research

OBJECTIVE: Evaluation of “near-miss” maternal mortality is a robust surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. To evaluate near-miss maternal mortality, we examined patient characteristics and maternal and neonatal outcomes for an obstetric population admitted to intensive care units (ICUs) in a tertiary care center.

METHODS: Pregnant and postpartum patients admitted to Duke University Medical Center ICUs from January 2005 to April 2011 were enrolled. Demographic, diagnostic, and outcome data were abstracted from the medical records for analysis.

RESULTS: A total of 86 women were included in the study. No participants were included more than once. The mean maternal age (±standard deviation) was 29.8±7.2 years. When racial and ethnic differences were examined, African American women were more likely to be admitted to the ICU. Significant ethnic differences in body mass index (BMI) were noted with African American women (mean BMI 35) and Hispanic women (mean BMI 36) having significantly higher BMIs than white women (mean BMI 28). The majority of patients (87%) were admitted postpartum. The mean length of stay was 10 days. The leading reason for admission to the ICUs was maternal cardiac disease (36%) followed by complications from hemorrhage (29%), sepsis (9%), and hypertensive disorders (9%). No significant racial or ethnic differences in maternal medical comorbidities or neonatal outcome were noted.

CONCLUSION: In this obstetric population, the leading reason for ICU admissions was cardiac disease. The increasing prevalence of advanced maternal age, congenital heart disease, obesity, diabetes, and hypertension among women who are of childbearing age may be contributing factors.


In a tertiary care center, severe maternal cardiac dysfunction is the leading cause of obstetric intensive care unit admission.

From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, North Carolina; and Yale University School of Public Health, New Haven, Connecticut.

Corresponding author: Maria J. Small, MD, MPH, Box 3967 DUMC, Durham, NC 27710; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists.