Analysis of maternal near miss cases in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20231204Keywords:
Maternal death, Maternal near miss, PregnancyAbstract
Background: The study of maternal near miss (severe maternal morbidity) is an alternative to study of maternal death. To reduce maternal mortality ratio (MMR), analysis of maternal near miss cases provide valuable information, which helps in implementing strategies to prevent maternal death. Aims and objectives were to determine maternal near miss indices and to analyse the causes of maternal near miss and other associated factors.
Methods: A retrospective analysis of health records of maternal near miss cases admitted to tertiary care hospital from October 2021 - September 2022 was done. Patient characteristics like age, parity, gestational age, risk factors, mode of delivery, lifesaving intervention were studied.
Results: A total of 9,744 patient admitted for seeking obstetric care and out of which there were 8,791 deliveries. A total of 164 maternal near miss cases and 24 maternal deaths were found during study period. The maternal near miss incidence ratio 18.76/1000 live birth, maternal near miss to mortality ratio 6.8:1 and mortality index was 12.7%. Hypertension and its complications are the most common cause for maternal near miss cases. Women in late trimester, multiparity, low education status, lack of awareness are at increased risk of near miss cases.
Conclusions: Hypertensive disorders in pregnancy and obstetric hemorrhage are leading cause for pregnancy specific obstetric disorder and anemia was found to be a leading cause for pre-existing condition aggravated during pregnancy. This study highlights the need for overall improvement in awareness among pregnant mothers and its timely accessibility with quality critical care management.
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References
Park K. Park’s textbook of preventive and social medicine. 26th edn. Jabalpur. Banarasidas Bhanot Publishers; 2021.
Pandya ST, Mangalampally K. Critical care in obstetrics. Indian journal of anaesthesia. 2018 Sep;62(9):724.
UNICEF. Maternal health. Available from: https://www.unicef.org/india/what-we-do/maternal-health. Accessed on 9 April 2020.
Nielsen HS, Eggebo TM. Millennium development goal 5--an obstetric challenge. Acta Obstet Gynecol Scand. 2012;91(9):1007-8.
Stones W, Lim W, Al-Azzawi F, Kelly M. An investigation of maternal morbidity with identification of life-threatening ‘near miss’ episodes. Health Trends. 1991;23(1):13-5.
Pattinson RC, Hall M: Near misses: a useful adjunct to maternal death inquiries. Br Med Bull. 2003;67:231-43.
Say L, Souza JP, Pattinson RC. Maternal near miss- towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287-96.
Galvão LP, Alvim-Pereira F, de Mendonça CM, Menezes FE, Góis KA, Ribeiro Jr RF, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth. 2014;14:1-8.
World Health Organization. The WHO Near-Miss Approach for Maternal Health. World Health Organization; 2011. Available from: http://www.who.int/reproductivehealth/0Ahttp://apps.who.int/iris/bitstream/10665/44692/1/9789241502221_eng.pdf. Accessed on 29 June 2019.
England N, Madill J, Metcafe 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):1-14.
Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: a pilot study of a definition for a near‐miss. BJOG. 1998;105(9):985-90.
Waterstone M, Murphy JD, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study Commentary: Obstetric morbidity data and the need to evaluate thromboembolic disease. BMJ. 2001;322(7294):1089-94.
van Roosmalen J, Zwart J. Severe acute maternal morbidity in high-income countries. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):297-304.
Souza JP, Cecatti JG, Parpinelli MA, Serruya SJ, Amaral E. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: a cross sectional study. BMC Pregnancy Childbirth. 2007;7(1):1-8.
Krishna Kumar M, Joshi A, Saraswat M, Jose T, Kapoor R, Saha M, et al. 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 Gynecol India. 2022:1-7.
Aoyama K, Pinto R, Ray JG, Hill AD, Scales DC, Lapinsky SE, et al. Association of maternal age with severe maternal morbidity and mortality in Canada. JAMA Network Open. 2019;2(8):e199875.
Koski-Rahikkala H, Pouta A, Pietiläinen K, Hartikainen AL. Does parity affect mortality among parous women? J Epidemiol Community Health. 2006;60(11):968-73.
Vandana, Krishnaswamy P. A prospective study of severe acute maternal morbidity and maternal near miss in a tertiary care hospital. J Obstet Gynecol India. 2022;72(1):19-25.
Ps R, Verma S, Rai L, Kumar P, Pai MV, Shetty J. “Near miss” obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:393758.
Karlsen S, Say L, Souza JP, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health. 2011;11:1-10.
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