Oral presentation: Sitaya Zomer

Background: Maternal mortality ratios (MMR) are statistically unstable in small-population settings, limiting their value for monitoring maternal health. Maternal near-miss (MNM) surveillance complements MMR by identifying women who survive life-threatening obstetric complications. The World Health Organization (WHO) developed standardized MNM criteria. Some countries, including Namibia, adapted these criteria to increase sensitivity in specific health-system contexts. MNM data from Curaçao have not yet been reported. This study compares WHO and Namibian MNM criteria in Curaçao, a high-income small-island setting with centralized obstetric care.

Methods: A retrospective cohort study was conducted at Curaçao Medical Center between November 2019 and December 2024. All deliveries, ectopic pregnancies, and abortions were included. MNM events and maternal deaths were identified using WHO and Namibian MNM criteria. WHO-recommended MNM indicators were calculated and agreement between criteria was assessed using Cohen’s κ and McNemar’s test.

Results: Among 6,449 pregnancies (5,879 live births), one maternal death occurred (MMR 16.6 per 100,000). WHO criteria identified 34 MNM cases (5.78/1,000 live births), compared to 71 cases using Namibian criteria (12.08/1,000 live births). Despite substantial agreement (κ = 0.74), Namibian MNM criteria identified significantly more cases (p < 0.0001). WHO criteria identified more severe MNM cases, whereas Namibian criteria included additional cases with lower severity.

Conclusion: Expanded MNM criteria increased case detection, but reduced specificity for identifying severe maternal morbidity. WHO criteria more accurately captured life-threatening obstetric events, supporting its use in high-functioning health systems. The MNM ratio on Curacao is lower than reported regional data, likely reflecting timely access to high-quality care.