Pan American Health Organization 
Recommendations for Establishing a National Maternal Near-miss Surveillance System in Latin America and the Caribbean [PDF ebook] 

From a pathophysiological perspective, death is the end result of a wide spectrum of complications leading to multi-organ dysfunction. However, there is a group of women who survive despite the seriousness of their condition, and is an outcome that depends primarily on the quality of health care services provided by a country or institution. This publication proposes an epidemiological surveillance system for the maternal near-miss (MNM) indicator, which refers to extremely severe maternal morbidity, i.e., cases that bring women very close to the death event, thus making it possible to estimate morbidity associated with diseases and complications that occur during pregnancy, childbirth, or the puerperium. After adjusting the definition to a specific population and time, MNM is defined as a case in which a woman nearly died, but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. This indicator has the logistical advantage that MNM always occurs in a health institution, since if the event occurs in the community or far from a health service, it will inevitably become a maternal death (and therefore no longer a MNM).It also provides more complete information on cases of preventable maternal death, incorporates patient safety issues, and helps detect deficiencies in health care systems. This work falls within the broader objective of the Pan American Health Organization to reduce maternal mortality and strengthen the epidemiological surveillance of maternal health at the national level. The tool provides national health authorities with a system to actively identify, collect, process, and analyze information related to MNM, and may also be useful to local and regional health care service providers and managers.