Fetal outcome in maternal near miss, retro-prospective study at tertiary centre


  • Preeti F. Lewis Department of Obstetrics and Gynecology, Grant Government Medical College and J. J. Group of Hospitals, Mumbai, Maharashtra, India
  • Bindu Gundaiah Department of Obstetrics and Gynecology, Grant Government Medical College and J. J. Group of Hospitals, Mumbai, Maharashtra, India
  • Nitin B. Bavdekar Department of Obstetrics and Gynecology, Grant Government Medical College and J. J. Group of Hospitals, Mumbai, Maharashtra, India




Maternal near-miss, Perinatal mortality, Fetal outcome


Background: Women are not dying because of diseases we cannot treat. They are dying because societies are yet to decide that their lives are worth saving. The statement completely comprises the unawareness of the importance of maternal health existing in society. As a result of which, there is still a lag in maternal health progression. As a part and parcel, fetal health is compromised giving rise to poor fetal outcomes. Studying fetal outcomes in such near-miss cases establishes a relationship between them.

Methods: A retro-prospective observational study, conducted in the Department of Obstetrics and Gynaecology. Study involves all women who are very ill pregnant or recently delivered women who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy and their fetal outcome during study period of 18 months.

Results: In a study of 3604 deliveries, MNM cases were 107 births. The MNM IR was 30/1000 live births, and the most common determinant leading to near-miss is hypertensive disorders followed by hemorrhage. Total perinatal mortality was 439 with a PNMR of 125/1000 births. Among the 107 near-miss cases perinatal mortality was seen in 29 pregnancies contributing to 6.6% of the total PNMR.

Conclusions: Fetal outcome improves with improvement in maternal health, as the maternal morbid condition is directly proportional to fetal outcome. This requires identifying and filling up gaps in the maternal health system to improve women’s health, further reducing fetal morbid conditions and consumption of neonatal resources.


Chhabra P. Maternal near miss: an indicator for maternal health and maternal care. Indian J Community Med. 2014;39(3):132-7.

Aspden P, Corrigan JM, Wolcott J. Patient Safety: Achieving a New Standard for Care. Washington (DC): National Academies Press (US); 2004.

Naderi T, Foroodnia S, Omidi S, Samadani F, Nakhaee N. Incidence and correlates of maternal near miss in southeast Iran. Int J Reprod Med. 2015;2015:914713.

Roopa PS, Verma S, Rai L, Kumar P, Pai M, Shetty J. Near miss obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;45: 56-9.

Sousa M, Cecatti J, Hardy E, Serruya S. Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance. Reprod Health. 2008;5(1):6-12.

Brace V, Penney G, Hall M. Quantifying severe maternal morbidity: a Scottish population study. BJOG. 2004;111(5):481-4.

Souze JP, Cecath JG, Faundes A, Morais SS, Villai J, Caroli G. Maternal near miss and maternal death in the World Health Organisation 2005 global survey on maternal and perinatal health. Bull World Heal Org. 2010;88:113-9.

Samant PY, Dhanawat J. Maternal near miss: An Indian tertiary care centre audit. Int J Reprod Contracept Obstet Gynecol. 2019;8:1874-79.

Kamboj A, Mandrelle K. Feto-maternal outcomes in near miss events in obstetrics. Int J Reprod Contracept Obstet Gynecol. 2020;43:23-7.

Rulisa S, Umuziranenge I, Small M, van Roosmalen J. Maternal near miss and mortality in a tertiary care hospital in Rwanda. BMC Pregnancy Childbirth. 2015;15:203.

Rathod AD, Chavan RP, Thool P. Analysis of near-miss and maternal mortality at tertiary referral centre of rural India. J Obstet Gynecol. 2016;66(S1):295-300.

Tallapureddy S, Velagaleti R, Palutla H, Satti CV. “Near-Miss” Obstetric events and maternal mortality in a Tertiary Care Hospital. Indian J Public Health. 2017;61(4):305-8.

Wasim T, Raana GE, Wasim M, Mushtaq J, Amin Z, Asghar S. Maternal near-miss, mortality and their correlates at a tertiary care hospital. J Pak Med Assoc. 2021;71(7):1843-8.

Kalisa R, Rulisa S, Akker TV, Roosmalen JV. Maternal Near Miss and quality of care in a rural Rwandan hospital. BMC Pregnan Childbirth. 2016;16:324-31.

Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on mortality of pregnant and postpartum women: a systematic review and meta-analysis. J Pregn. 2021;2021:8870129.

Elsaddig M, Khalil A. Effects of the COVID pandemic on pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;73:125-36.

McDonnell S, McNamee E, Lindow SW, O'Connell MP. The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;255:172-6.

Papapanou M, Papaioannou M, Petta A, Routsi E, Farmaki M, Vlahos N. Maternal and neonatal characteristics and outcomes of COVID-19 in pregnancy: an overview of systematic reviews. Int J Environ Res Publ Health. 2021;18:45-9.

Gold S, Saeed H, Mokhtari N, Chornock RL, Fries M, Overcash R. 564 Comparison of clinical outcomes in pregnant women with and without COVID-19 based on disease severity. Am J Obstet Gynecol. 2021;224: S357.

O'Malley EG, Popivanov P, Fergus A, Tan T, Byrne B. Maternal near miss: what lies beneath? Eur J Obstet Gynecol Reprod Biol. 2016;199:116-20.

Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG. 2012;119(6):653-61.

Jayaratnam S, Burton A, Connan KF, de Costa C. Maternal 'near miss' at Royal Darwin Hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit. Aust N Z J Obstet Gynaecol. 2016;56(4):381-6.

Banaei M, Ghasemi V, Saei Ghare Naz M, Kiani Z, Rashidi-Fakari F, Banaei S, Mohammad Souri B, Rokni M. Obstetrics and Neonatal Outcomes in Pregnant Women with COVID-19: A Systematic Review. Iran J Public Health. 2020;49(1):38-47.

Guidelines for maternal near-miss. Available at: https://www.Maternal_Near_Miss_Operational_Guidelines.pdf. Accessed on 24 October 20121.

Herklots T, van Acht L, Khamis RS, Meguid T, Franx A, Jacod B. Validity of WHO’s near-miss approach in a high maternal mortality setting. PLoS ONE. 2019;14(5):e0217135.

Tunçalp Ö, Souza JP. Maternal near-miss audits to improve quality of care. BJOG. 2014;121(4):102-4.

Murki A, Dhope S, Kamineni V. Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit. J Matern Fetal Neonatal Med. 2017;30(5):585-7.






Original Research Articles