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Background Analysis of “maternal near-misses” is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization’s MNM approach. Methods A five-year retrospective study was conducted in Subei People’s Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. Results Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40–7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66–14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53–11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20–18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). Conclusions Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.

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BackgroundThe maternal near-miss (MNM) criterion formulated by the WHO can dynamically evaluate the obstetric quality and maternal health in medical institutions. The study aims to explore the incidence, risk factors, and causes of MNM cases admitted to the intensive care unit (ICU) within 5 years.MethodsThis study is a retrospective study. The data of MNM admitted to the ICU comes from the medical records of Subei People's Hospital in Yangzhou from 2015 to 2019. The study subjects meet at least one World Health Organization (WHO) criterion of MNM. The MNM who had not been admitted to the ICU in the same year served as the control group. We use descriptive analysis, Chi-Square test and Fisher’s exact test for data analysis.Results151 women met the WHO criteria of MNM and there was one maternal death in 2016. The average maternal near-miss rate（MNMR）for ICU admission was 3.5 per 1,000LBs, and the average MNM morbidity was 0.36%. The average maternal mortality ratio (MMR) was 5 per 100,000LBs. The 5-year research period witnessed moderate growth in MNM admitted to the ICU. The region, referral, gravidity, prenatal examination, and mode of delivery were significantly related to the MNM admitted to the ICU(p<0.05). Concerning neonatal characteristics, there is a significant difference in preterm birth rate and low Apgar scores at 1 min and 5 min(p<0.05). The direct obstetric causes were the primary cause of MNM, regardless of the ICU admission. The leading direct obstetric causes of MNM admitted to the ICU were obstetric hemorrhage diseases(38.8%)，following hypertension diseases(18.8%), while the leading indirect obstetric cause of MNM admitted to the ICU was heart-related diseases (7.2%). MNM for the ICU admission were mostly postpartum (96.9%), who underwent multiple interventions.ConclusionsICU is one of the most important endpoints of MNM management. In the context of "universal two-child", medical institutions should strengthen multidisciplinary joint treatment. In the future, it needs to be expanded to multi-center research to determine the criteria for MNM admitted to the ICU.