Near-Miss Maternal: Understanding to Save More Lives

Introduction: Maternal cardiorespiratory arrest (MCRA) represents a rare but critical obstetric emergency, frequently associated with high maternal and fetal mortality. Swift and efficient resuscitative measures are essential for a favorable outcome. Patients who survive such events are considered "near-miss" cases. This study focuses on patients who experienced MCRA and were successfully resuscitated-referred to as near-miss cases or "narrow escapes." Methods: This was a descriptive cross-sectional study utilizing retrospective data collection over a five-year period. Included were medical records of pregnant, laboring, or postpartum patients admitted to the CHU-MEL during the study interval who presented with a severe obstetric complication-whether or not cardiorespiratory arrest occurred-and were successfully resuscitated during hospitalization. Data were obtained from operating room and intensive care unit registries, patient medical files, and maternal mortality audit reports. Results: The incidence of near-miss events was 42.5%. The mean age of patients was 29.72 ± 5.78 years. Upon admission, 54.5% of patients exhibited signs of clinical distress. Cardiorespiratory arrest occurred in 80.8% of cases, compared to isolated respiratory arrest in 16.1%. In 98.9% of instances, medical personnel were the first responders to the arrest. An emergency alert was activated promptly in 93.9% of cases. External cardiac massage was administered in 90.9% of patients, while resuscitative care by the anesthesia and critical care team was rendered in 92.9%. A total of 145 patients (42.5%) regained cardiac activity following cardiopulmonary resuscitation and were categorized as near-miss survivors. Conclusion: This study conducted at CHU-MEL in Cotonou from 2020 to 2024 quantified the hospital frequency of near-miss maternal cardiorespiratory arrests and detailed their clinical course and management. To improve maternal outcomes, it is imperative to anticipate such emergencies and ensure immediate access to trained healthcare personnel and resuscitation equipment.