An analysis of the levels of delay seen in maternal near miss cases in India
Keywords:Maternal morbidity, Near miss, Maternal mortality, High risk obstetrics
Background: The measure of progress of maternal health has usually been a reduction in maternal mortality but if you look at maternal health as an iceberg – maternal deaths are only seen as the tip, with maternal morbidity as the base. As for every woman that dies of maternal causes, 20-30 others experience severe maternal morbidity, sometimes with permanent consequences affecting their daily functioning.
Methods: We conducted a prospective observational and clinical study at D. Y. Patil Hospital in Navi Mumbai, India from November 2018 to October 2020 from critically ill, pregnant, laboring, post-partum or post-abortal women that were admitted to the hospital and the levels of delay and barriers to health were carefully asked from the proforma and tabulated.
Results: The most common cause of delay was delay 1 in 48.6% cases followed by delay 2 in 31.9% patients. 18.1% patients had no delay noted followed by 1.4% patients that had a level 3 delay. This study found significant association with antenatal care with type of delay experienced during maternal near miss. Women that had not taken appropriate antenatal care in pregnancy had a higher association to type 1 delay.
Conclusions: We have learnt that social determinants are important contributors to the causes of near miss delays and eventual maternal mortalities and these social determinants depend on many social levels. Addressing maternal deaths requires action at every level, not just medical or health services. Understanding the delays in receiving care helps analyze patterns of maternal near miss cases and consequently maternal deaths.
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