Study of maternal near miss as an indicator of quality of obstetrics care in tertiary care centre: a prospective study

Authors

  • Priyanka Patel Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
  • Jagriti Kiran Nagar Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
  • Rajesh Kumar Patel Dr. Rai Hospital, Sagar, Madhya Pradesh, India
  • Siftie Kaur Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231924

Keywords:

Intensive care unit, Maternal near miss, Morbidity, Mortality

Abstract

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, childbirth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near miss cases five factor scoring system was used. In 2009 WHO working group has standardized the criteria for these cases.

Methods: The study was a descriptive study done for the period of 18 months between 1st June 2021 to 31st December 2022 conducted in the department of Obstetrics and Gynecology at Bundelkhand Medical College Sagar, Madhya Pradesh, India, which is a tertiary care centre. For each cases of near miss, data were collected on demographic characteristics including gestational age at the time of sustaining the near morbidity, nature of obstetric complications, presence of organ dysfunction/failure, ICU admission and timing of near miss event with respect to admission.

Results: A total numbers of 12252 live births were, 28 maternal deaths and 372 MNM cases were reported during the study period. Incidence of MNM was 30.3 %. In present study mortality index is 0.07. Maternal near miss to mortality ratio is 13.2:1. Hypertensive disorder of pregnancy 44.4% were most common cause of MNM followed by severe anemia 23% cases.

Conclusions: Critical analysis of MNM cases will help us in identifying the deficiencies in obstetric care. Maternal mortality and morbidity can be reduced if timely and effective care can be given to women experiencing acute pregnancy related complications .There is need for validation of MNM criteria at peripheral level which will enable them in early identification and timely referral of such cases to tertiary centers.

References

National Health Mission. Home, 2019. Available at: https://mohfw.nic.in/maternalhealth.htmp. Accessed 20 August 2021.

UN. 2. Sustainable development goals: 17 goals to transform our world, 2019. A goal to transform our world, 2019. Available at: https://www.un.org/sustevelopment/health. Accessed 20 August 2021.

Chikadaya H, Madziyire MG, Munjanja SP. Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study. BMC Preg Childb. 2018;18(1):458.

Parmar N, Parmar A, Mazumdar VS. What can we miss in identifying ‘maternal near miss’ event? IJCRR. 2014;6:45-50.

WHO. Evaluating the quality of care for severe pregnancy complications. The WHO near miss approach for maternal health, 2019. Available at: https://www.who.int/reproductivehealth/publications/monitoring/9789241502221/en. Accessed 20 August 2021.

Yelikar KA, Deshpande SS, Deshmukh SF. Severe acute maternal morbidity in a tertiary care center with basic intermediate respiratory care units setup. Int J Sci Stud. 2015;3(5):36-40.

Bakshi RK, Aggarwal P, Roy D, Nautial R. Indicators of maternal “near miss” morbidity at different levels of health care in North India: A pilot study. Bangladesh J Med Sci. 2015;14(3):254-57.

Kaur S, Minhas S, Sharma BR, Sood R. Maternal near miss and maternal mortality as health indicators in a tertiary care hospital. J Evolut Med Dent Sci. 2014;3(41):10354-62.

Kaur K, Garg S, Walia SS. A one year audit of maternal near miss and maternal death at tertiary care hospital. JMCSR. 2018;6:705-10.

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.

Patanakar A, Uikey P, Rawlani N. Severe acute maternal morbidity (near miss) in a tertiary care center in Maharashtra: a prospective study. Int J Sci Stud. 2016;4(1):134-40.

Samant PY, Dhanawat J. Maternal near miss: an Indian tertiary care center audit. Int J Reprod Contracept Obstet Gynecol. 2019;8(5):1874-9.

Taly A, Gupta S, Jain N. Maternal intensive care and ‘Near-miss’. Mortality in obstetrics. J Obstet Gynecol India. 2004;54:478-82.

Roost M, Altamirano V, Liljestrand J, Essen B. Priorities in emergency obstetrics care in Bolivia-maternal mortality and near miss morbidity in metropolitan La Paz. BJOG. 2019;116(9):1210-17.

Manandhar SR, Manandhar D, Adhikari D, Shreshta J, Rai C, Rana H, et al. Analysis of obstetrics near miss cases of different health facilities of electoral constituency 2 of Arghakhanchi district. Nepal J Obstet Gynecol. 2014;9(2):38-41.

Kalra P, Kachhwaha CP. Obstetrics near miss morbidity and maternal mortality in a Tertiary care center in Western Rajasthan. Ind J Pub Heal. 2014;58(3):199-201.

Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of obstetric near miss and maternal deaths in a tertiary care hospital in north India: Shifting focus from mortality to morbidity. J Obstet Gynecol India. 2014;64(6):394-9.

Rajkumari P, Manonmani. Maternal near Miss: an indicator of maternal health. IOSR J Dental Med Sci. 2017;3(16):9-15.

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Published

2023-06-28

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Original Research Articles