To reduce maternal mortality, it is important to analyze the clinical conditions posing a potential threat to pregnant women. To characterize such states, the definition was introduced – “maternal morbidity, which almost took the woman’s life” (the near miss maternal morbidity), or the “near miss”. The “near miss” criteria were first defined in 2009. This review article provides a rationale for auditing the “near miss” cases for the purposes of healthcare technologies asessment. The paper also discusses the clinical and economic aspects of “near miss” analysis and the methodology for assessing the “near miss” incidence. Also of scientific and practical interest is the classification of maternal “near miss” cases developed by our colleagues from theRostovPerinatalCenter. Thus, maternal “near miss” cases are divided into obstetric (emergency), extragenital, planned (managed), organizational, and iatrogenic. This differentiated approach to the maternal critical conditions allows us to understand not only their causes, but also to develop a plan of further actions for each specific group. This contributes to the development of rehabilitation and prevention measures to be taken during subsequent pregnancies.

Although maternal mortality cases in Russia have become rare, the problem of their prevention remains relevant. To enforce the preventive measures, an analysis of critical conditions and «near miss» cases in obstetrics is commonly used. As a result, the quality of medical care in obstetric institutions improves. Aim: to assess the character and incidence of critical situations in obstetrics practice over the Ryazan region in 2015-2017 and to analyze the failures in medical care that led to such situations. Materials and methods. We analyzed 46 «near miss» cases and 1 case of maternal death recorded in the Ryazan region in 2015-2017. Results. The leading cause of critical conditions in obstetrics found in the Ryazan region was hemorrhage following an emergency caesarean section delivery. In most cases, bleeding was caused by pregnancy complications, although extragenital conditions also contributed to the development of the «near miss» situations. The main indication for emergency delivery was the premature detachment of a normally located placenta; in the normal term delivery, it was an inconsistent uterine scar after cesarean section and the accompanying pathology, such as placenta accreta. Conclusion. Considering the «near miss» cases as a separate group of obstetrics conditions contributes to the prevention of maternal mortality and improves the healthcare standards in obstetric institutions.

Objective of the Paper: To present a clinical case of renal angiomyolipoma rupture during pregnancy and describe the steps in its diagnosis and a treatment approach that led to a favorable clinical outcome. Key Points: Spontaneous rupture of the kidney is a rare condition with severe complications, especially during pregnancy. One possible cause of this condition is rupture of a renal tumor (angiomyolipoma), with pregnancy being a trigger for the tumor growth of this kind of neoplasm. Because it is rare, angiomyolipoma is most often detected incidentally during an examination. It is mainly diagnosed by renal ultrasound. This paper discusses the main characteristics of angiomyolipoma, describes a clinical case of this tumor in a pregnant woman, and provides information about a promising method for preventing angiomyolipoma proposed by foreign authors. Conclusion: Assessment of the urinary tract should be done routinely during one of the prenatal ultrasound screenings, as a preventive measure against urinary tract emergencies in pregnant women. Keywords: spontaneous rupture of the kidney, renal angiomyolipoma, pregnancy.