Critical near-miss conditions in obstetrics: difficulties in diagnosis and therapy


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Abstract

Background. A near-miss (NM) woman is a pregnant or puerperal woman in the critical condition - near death during pregnancy, childbirth, or within 42 days after delivery and who has survived the specified period. The management of obstetric patients who are on the verge of life and death (near miss) always presents great difficulties and requires a multidisciplinary approach, the use of modern diagnostic and treatment methods, and the mobilization of significant material investments. Analysis of obstetric near misses is the subject of a systematic study, which can assess the quality and level of organization of the work at the health care facilities providing specialized obstetric/gynecological care. Case report. The paper analyzes the management and treatment of a patient from the near-miss category with HELLP syndrome, sepsis, secondary thrombotic microangiopathy, and acute kidney injury, which are manifested after operative delivery. Conclusion. The timely and rapid routing of a patient to a third-level obstetric health care facility, the use of modern high-tech diagnostic and treatment methods contributed to the preservation of life in the patient and her hospital discharge in satisfactory condition.

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About the authors

Aleksey V. Pyregov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_pyregov@oparina4.ru

Roman G. Shmakov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: r_shmakov@oparina4.ru

Tatiana A. Fedorova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: t_fyodorova@oparina4.ru

Maria V. Yurova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: m_yurova@oparina4.ru

Oleg V. Rogachevsky

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: https://orcid.org/0000-0002-4332-430X

Konstantin I. Grishchuk

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_grishuk@oparina4.ru

Elena V. Strelnikova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: _strelnikova@oparina4.ru

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