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Objective Evaluation of "near-miss" maternal mortality is a robust surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. To evaluate near-miss maternal mortality, we examined patient characteristics and maternal and neonatal outcomes for an obstetric population admitted to intensive care units (ICUs) in a tertiary care center. Methods Pregnant and postpartum patients admitted to Duke University Medical Center ICUs from January 2005 to April 2011 were enrolled. Demographic, diagnostic, and outcome data were abstracted from the medical records for analysis. Results A total of 86 women were included in the study. No participants were included more than once. The mean maternal age (±standard deviation) was 29.8±7.2 years. When racial and ethnic differences were examined, African American women were more likely to be admitted to the ICU. Significant ethnic differences in body mass index (BMI) were noted with African American women (mean BMI 35) and Hispanic women (mean BMI 36) having significantly higher BMIs than white women (mean BMI 28). The majority of patients (87%) were admitted postpartum. The mean length of stay was 10 days. The leading reason for admission to the ICUs was maternal cardiac disease (36%) followed by complications from hemorrhage (29%), sepsis (9%), and hypertensive disorders (9%). No significant racial or ethnic differences in maternal medical comorbidities or neonatal outcome were noted. Conclusion In this obstetric population, the leading reason for ICU admissions was cardiac disease. The increasing prevalence of advanced maternal age, congenital heart disease, obesity, diabetes, and hypertension among women who are of childbearing age may be contributing factors. Level of evidence III.

Objective: Menorrhagia, excessive menstrual bleeding, affects up to 20% of reproductive-aged women. Underlying bleeding disorders, such as von Willebrand’s disease (vWD) and platelet abnormalities, may present as menorrhagia. Gynecologists do not routinely screen women with menorrhagia for bleeding disorders. The purpose of this preliminary study was to detect underlying bleeding disorders in women with menorrhagia using a new screening test. Methods: Reproductive-aged women with a diagnosis of menorrhagia were identified. Participants were screened using the PFA-100 (Dade Behring, Inc., Miami, FL), an in vitro platelet function analyzer found to be both sensitive (95%) and specific (88%) in the detection of vWD and platelet disorders. A positive test result was defined as prolonged time until clot formation. Results were confirmed with additional testing. Results: During the first 8 months of the study, 43 women were enrolled. The median age was 40 years. Twenty-one (49%) were white, 21 (49%) were African American, and 1 (2%) was Asian. Sixteen of the 43 women had a positive PFA-100 test result. Eleven had positive results suggestive of aspirin use. Five (12%) were found to have an underlying bleeding disorder: two with vWD and three with platelet abnormalities. Conclusions: Our preliminary findings suggest that the PFA-100 is useful in the evaluation of women with menorrhagia. A significant number of these women appear to have underlying bleeding disorders.