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A “near miss case “ refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days (6 weeks) of termination of pregnancy. This manual describes the near-miss case review (NMCR) cycle, which is a continuous process to improve the quality of patient care and outcomes in facilities by systematic review of care against explicit criteria and implementation of changes. This manual focuses on reviews of individual cases of maternal “near-misses” in facilities, and more specifically on introducing the NMCR approaches in a country, organizing an NMCR session in a hospital, and assuring the quality of the NMCR cycle. It is intended for hospital staff involved in maternal and newborn health care, for program managers and policy-makers who are responsible for the quality of perinatal health care at ministries of health or in facilities, for the United Nations agencies and development partners that support maternal and newborn health care.