The prevalence and risk factors for severe maternal morbidity at a tertiary care centre in western India

Jyotika Himmatsinh Rathwa; Purvi Kanubhai Patel; Neha Kumari Soni

doi:10.18203/2320-1770.ijrcog20261280

Authors

Jyotika Himmatsinh Rathwa Department of Obstetrics and Gynecology, Baroda Medical College, S.S.G. Hospital, Vadodara, Gujarat, India
Purvi Kanubhai Patel Department of Obstetrics and Gynecology, Baroda Medical College, S.S.G. Hospital, Vadodara, Gujarat, India
Neha Kumari Soni Department of Obstetrics and Gynecology, Baroda Medical College, S.S.G. Hospital, Vadodara, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261280

Keywords:

Antenatal care, Caesarean section, Maternal near miss, Pregnancy complications, Severe maternal morbidity

Abstract

Background: Severe maternal morbidity (SMM) is an important indicator of maternal health, especially as maternal mortality declines. For every maternal death, 20-30 women experience significant pregnancy-related complications. SMM includes serious, potentially life-threatening conditions during pregnancy, labor, or the postpartum period. Although maternal near miss (MNM) has been widely studied, data on SMM remain limited. This study aimed to determine the prevalence of SMM and identify associated risk factors among women delivering at a tertiary care hospital in Vadodara, Gujarat.

Methods: This hospital-based cross-sectional study was conducted in the labor room of S.S.G. Hospital, Vadodara. Women aged 18 years or older undergoing delivery and fulfilling at least one CDC-defined SMM criterion were included. Socio-demographic characteristics, antenatal care details, obstetric history, pregnancy complications, mode of delivery, and maternal outcomes were recorded and analyzed descriptively.

Results: The prevalence of SMM was 72.38% (185 women). Most were aged 20-29 years (59.46%), and 87.03% were referred cases. Inadequate antenatal care (<4 visits) was observed in 36.76%. Hypertensive disorders (31.85%) and severe anemia (10.95%) were common complications. Caesarean section was performed in 40% of cases. Blood transfusion was required in 45.41%, and 5.41% had hospital stays exceeding 14 days.

Conclusions: SMM was markedly higher than MNM, underscoring its value as a tool for improving maternal healthcare. Hemorrhage, hypertensive disorders, anemia, inadequate antenatal care, and previous caesarean section were key contributors.

References

Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalisations in the United States. Obstet Gynecol. 2012;120(5):1029-36.

Ryan HM, Sharma S, Magee LA, Ansermino JM, MacDonell K, Payne BA, et al. The usefulness of the APACHE II score in obstetric critical care: a structured review. J Obstet Gynaecol Can. 2016;38(10):909-18.

Say L, Souza JP, Pattinson RC; WHO Working Group on Maternal Mortality and Morbidity Classifications. 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.

Lapinsky SE, Kruczynski K, Seaward GR, Farine D, Grossman RF. Critical care management of the obstetric patient. Can J Anaesth. 1997;44(3):325-9.

Lewis G. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Br Med Bull. 2003;67(1):27-37.

de Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JE, Vasconcelos MX. Severe maternal morbidity: a case-control study in Maranhão, Brazil. Reprod Health. 2013;10(1):11.

Lindquist A, Knight M, Kurinczuk JJ. Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study. BMJ Open. 2013;3(6):e002742.

Liu S, Joseph KS, Hutcheon JA, Bartholomew S, León JA, Walker M, et al. Gestational age-specific severe maternal morbidity associated with labour induction. Am J Obstet Gynecol. 2013;209(3):209.e1-8.

van Mello NM, Zietse CS, Mol F, Zwart JJ, van Roosmalen J, Bloemenkamp KW, et al. Severe maternal morbidity in ectopic pregnancy is not associated with maternal factors but may be associated with the quality of care. Fertil Steril. 2012;97(3):623-9.

Norhayati MN, Nik Hazlina NH, Aniza AA, Sulaiman Z. Factors associated with severe maternal morbidity in Kelantan, Malaysia: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2016;16(1):185.

Oliveira FC Jr, Costa ML, Cecatti JG, Pinto e Silva JL, Surita FG. Maternal morbidity and near miss associated with maternal age: Brazilian demographic health survey 2006. Clinics (Sao Paulo). 2013;68(7):922-7.

Grey KE, Wallace ER, Nelson KR, Reed SD, Schiff MA. Population-based study of risk factors for severe maternal morbidity. Paediatr Perinat Epidemiol. 2012;26(6):506-14.

Roost M, Altamirano VC, Liljestrand J, Essen B. Does antenatal care facilitate utilisation of emergency obstetric care? Acta Obstet Gynecol Scand. 2010;89(3):335-42.

van Dillen J, Zwart JJ, Schutte J, Bloemenkamp KW, van Roosmalen J. Severe acute maternal morbidity and mode of delivery in the Netherlands. Acta Obstet Gynecol Scand. 2010;89(11):1460-5.

Geddes-Barton D, Baldelli S, Karthikappallil R, Bentley T, Omorodion B, Thompson L, et al. Association between socioeconomic disadvantage and severe maternal morbidity and mortality in high-income countries: a systematic review. J Epidemiol Community Health. 2025;79(3):207-15.

Lindquist A, Knight M, Kurinczuk JJ. Variation in severe maternal morbidity according to socioeconomic position: a UK national case–control study. BMJ Open. 2013;3(6):e002742.

Beyuo TK, Lawrence ER, Oppong SA, Kobernik EK, Amoakoh-Coleman M, Grobbee DE, et al. Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Pregnancy Hypertens. 2023;33:46-51.

Eshetu D, Aschalew Z, Bante A, Negesa B, Gomora D, Ejigu N, et al. Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers in Bale zones, Ethiopia. PLOS Glob Public Health. 2024;4(2):e0002964.

Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1(1):3.

Hawkins SS, Harper S, Baum CF, Kaufman JS. Associations between state-level changes in reproductive health services and indicators of severe maternal morbidity. JAMA Pediatr. 2023;177(1):93-95.

Alluvala SA, Aziz N, Tumkur A, Boorugu HK. One-year follow-up of women with severe acute maternal morbidity (SAMM): a cohort study. J Obstet Gynaecol India. 2019;69(3):211-7.

Rajbanshi S, Norhayati MN, Nik Hazlina NH. Severe maternal morbidity and its associated factors in Morang district, Nepal. PLoS One. 2021;16(12):e0261033.

Minkauskiene M, Nadisauskiene R, Padaiga Z, Makari S. Incidence and prevalence of severe maternal morbidity: a systematic review. Medicina (Kaunas). 2004;40(4):299-309.

Desai GS, Ghosh K, Pandya SV. Prevalence and associated risk factors of reproductive morbidity in Gujarat: evidence from NFHS-IV. Int J Community Med Public Health. 2022;9(6):2493-2500.

Jayawardane IA, Jayasundara DMCS, Weliange SDS, Jayasingha TDKM, Madugalle TMSSB, Nishshanka NMCL. Long-term morbidity following peripartum hysterectomy: a systematic review. Int J Gynaecol Obstet. 2025;170(3):988-1000.

National Research Council (US). The consequences of maternal morbidity and maternal mortality: report of a workshop. Washington (DC): National Academies Press; 2000.

Koblinsky M, Chowdhury ME, Moran A, Ronsmans C. Maternal morbidity and disability and their consequences: neglected agenda in maternal health. J Health Popul Nutr. 2012;30(2):124-30.

Say L, Barreix M, Chou D, Tunçalp Ö, Cottler S, McCaw-Binns A, et al. Maternal morbidity measurement tool pilot: study protocol. Reproduct Heal. 2016;13(1):69.

Mantel G, 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.

de Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JE, Vasconcelos MX. Severe maternal morbidity: a case-control study in Maranhao, Brazil. Reproduct Heal. 2013;10(1):11.

Attali E, Yogev Y. The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2021;70:2-9.

Galvão LP, Alvim-Pereira F, de Mendonça CM, Menezes FE, Góis KA, Ribeiro RF Jr, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Northeast Brazil. BMC Pregnancy Childbirth. 2014;14(1):25.

Dias MA, Domingues RM, Schilithz AO, Nakamura-Pereira M, Diniz CS, Brum IR, et al. Incidence of maternal near miss in hospital childbirth and postpartum: Birth in Brazil study. Cad Saude Publica. 2014;30(Suppl 1):S1-12.

Halder A, Jose R, Vijayselvi R. Maternal mortality and derivations from the WHO near-miss tool: an institutional experience over a decade in Southern India. J Turk Ger Gynecol Assoc. 2014;15(4):222-7.

Kayem G, Kurinczuk J, Lewis G, Golightly S, Brocklehurst P, Knight M. Risk factors for progression from severe maternal morbidity to death: a national cohort study. PLoS One. 2011;6(12):e29077.

Conde-Agudelo A, Belizán JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America. Am J Obstet Gynecol. 2012;206(1):45.e1-8.

Singh A, Jain K, Soni RK. Impact of religion on health practices in India. J Family Med Prim Care. 2018;7(2):244-9.