Des catastrophes obstetricales evitees de justesse: les near-miss dans les hopitaux marocains.

A consensus definition of obstetric catastrophes barely only just avoided, called near miss cases in the recent scientific literature, has been elaborated during an international seminar held in Morocco. A near miss case was defined as "any pregnant or recently delivered - or aborted - woman, whose immediate survival is threatened and who survives by chance or because of the hospital care received". This definition was then operationalised using severity criteria combining clinical signs and types of intervention clear enough to easily screen near miss cases in hospital files. These criteria were then used to identify the near misses that occurred in 1998 in two public Moroccan hospitals (Tetouan and Sidi Kacem). A total of 81 cases of severe maternal complications (76 near misses and 5 deaths) were collected, a frequency of 11.9% among hospital admissions for delivery or pregnancy complications. The interest and limitations of such a near miss case definition are discussed. It seems that the criteria applied were operational in the Moroccan context. They are specific, i.e. they permitted to identify true cases of mother's life threatening complications. Finally, they generated a sufficiently great number of cases and a range of situations large enough to hold monthly audits and to identify sub-standard care.