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Pregnant patients have a generally poor understanding of preeclampsia, although improved understanding is associated with having received information about the disease. Further investigation will be needed to determine how best to educate patients and whether this education can also decrease adverse outcomes associated with this syndrome.

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Little progress has been made in the effort to lower the rate of maternal mortality in the United States over several decades. 1 Indeed, recent data suggest that this rate may actually be rising. 2 This lack of progress is further demonstrated by the inability to narrow the racial disparities that exists between white, black, and Hispanic populations with regard to maternal mortality. 1 These data cumulatively serve to emphasize the need to improve perinatal care. However, despite the unacceptable epidemiological trends of maternal mortality rate in the United States, the absolute number of cases remains quite low and is infrequent at any one institution. Because the number of women who die as a result of pregnancy is so low, evaluation of maternal mortality cases as a tool to improve perinatal health has a limited utility. It is difficult to discern patterns of care that need refinement with such a small number of applicable cases. As maternal morbidity is orders of magnitude more common than maternal mortality, expanding the focus of case review to include maternal morbidity would provide a larger population of interest. 3 The broadening of the focus to maternal morbidity has the potential to give insight into methods to reduce maternal mortality, lessen racial disparities in adverse obstetric outcomes, and identify preventable factors that lead to poor maternal outcome. Before morbidity can be effectively studied, however, a standard metric needs to be developed. The Keywords ► near-miss morbidity ► maternal mortality ► scoring system Abstract Objective To validate a five-factor scoring system that identifies parturients who experience near-miss morbidity. Study Design and Setting This study was conducted in an urban, tertiary care hospital over a 2-year period. A narrative case summary was prepared for women with high potential for significant obstetric morbidity. The summary was then reviewed by three physicians, and the extent of morbidity was assigned based on subjective assessment. The same cases were then scored using the proposed five-factor scoring system previously described by Geller et al. Test characteristics of the scoring system were assessed. Results Eight hundred fifteen cases with a high potential for significant morbidity were identified. Subjective review and the scoring system classified 4.5% and 4.2% as nearmiss morbidity, respectively, with the scoring system having a corresponding sensitivity of 81.1% (95% confidence interval 64.8 to 92.0%) and a specificity of 99.5% (95% confidence interval 98.7 to 99.9%). Conclusion The scoring system produced similar results to those obtained at its initial development and demonstrated acceptable sensitivity and specificity for identifying near-miss morbidity.

The ovary and cervix are the most common primary sites of gynecologic malignancies in patients 25 years of age or younger. Health maintenance programs for patients in this age group should continue to include pelvic exams and Pap test screening.

The mean readability was above the recommended 6th grade reading level. The content, readability, and actionability of preeclampsia patient education materials should be improved.