Published: 2022-04-27

Maternal near miss events, an obstetrician's nightmare

Kalyani S., Prashanthi S. S.


Background: Near-miss obstetric cases are those who have survived childbirth after a life-threatening complication of pregnancy. The aim of this study is to assess the prevalence of maternal near miss events, fetomaternal outcome and alongside analyze the importance of high dependency unit care for near miss patients in reducing maternal morbidity and mortality.

Methods: This hospital based cross-sectional study was conducted in the obstetrics and gynaecology department of Southern railway hospital during June 2019 July 2021. In this study, pregnant or postnatal women with life threatening complications are admitted to the HDU using SAMM composite score and maternal & perinatal outcome are documented. Data entry was done in Microsoft Excel and data were analyzed using Epi Info software (

Results: Many indicators of maternal near miss are calculated. The incidence of near-miss events was 11.5/1,000 live births. The ratio of near-miss to maternal mortality was 7:1. Hypertensive disorders complicating pregnancy and Obstetric haemorrhage were the most common direct and cardiac diseases complicating pregnancies were the most common indirect causes of admission into HDU care.

Conclusions: Evaluation of maternal near miss events provides a good sense about our deficiencies in referral system, treatment protocols and any delay in admission to intervention time. Good maternal outcome after HDU care in MNM patients and also cost-effective benefits.


Maternal near miss, HDU, SAMM score, Maternal mortality

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England N, Madill J, Metcalfe A, Magee L, Cooper S, Salmon C, et al. Monitoring maternal near miss/ severe maternal morbidity: A systematic review of global practices. PLoS ONE. 2020;15(5):e0233697.

Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tuncalp O, et al. Measuring maternal health: focus on maternal morbidity. Bulletin of the World Health Organization. 2013;91(10):794-6.

Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, et al. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016; 388(10056):2164-75.

Heath statistics and information system: Maternal mortality ratio (per 100000 live births). Available at: maternal-mortality. Accessed on 20 November 2021.

Pregnancy Mortality Surveillance System-Pregnancy Reproductive Health. Available at: https://www.cdc. gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm. Accessed on 20 November 2021.

Trends in maternal mortality: 2000 to 2017. Available at: ations/maternal-mortality-2000-2017/en/. Accessed on 20 November 2021. Accessed on 20 November 2021.

Ganchimeg T, Ota E, Morisaki N. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(1):40-8.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health. 2014;2(6):e323-33.

Trends in Maternal Mortality: 1990 to 2015. Available at: trends-maternal-mortality-1990-201. Accessed on 20 November 2021.

Kurugodiyavar A, Mahesh D. Determinants of maternal near miss events: a facility based case-control study. Int J Commu Med Public Health. 2011; 6(8): 3614-20.

Sarma HKD, Sarma HK, Kalita AK. A prospective study of maternal near-miss and maternal mortality cases in FAAMCH, Barpeta; with special reference to its aetiology and management: First 4 months report. J Obstet Gynaecol. 2015;1(2):100-6.

Sultana A, Ishtiaque S, Fareed S. Clinical spectrum of near-miss cases in obstetrics. Cureus. 2019;11(5): e4641.

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

Krishna KM, Joshi A, Saraswat M. Near-miss incidents in obstetric patients admitted to an intensive care unit of a tertiary care center in eastern India: a retrospective cohort study. J Obstet Gynaecol India. 2021;17:45-9.

Sharma C, Yadav A, Mehrotra M, Saha MK, Tambe RR. Maternal near miss: unraveling our experience in the tertiary care hospital of Andaman and Nicobar Islands. Indian J Community Med. 2021;46(1):35-9.

Bhatia R, Mor S, Manzoor S. Severe cardiac dysfunction in pregnancy- a maternal near miss. J Evol Med Dent Sci. 2020;9(09):700-2.