Maternal near-miss following severe postpartum hemorrhage: a case series of 22 women from a tertiary care center

Abstract

Maternal near-miss (MNM) events are important indicators of the quality of obstetric care, with postpartum hemorrhage (PPH) remaining one of the leading causes of severe maternal morbidity, particularly in low- and middle-income countries. This case series aimed to evaluate the clinical profile, management strategies, and outcomes of women experiencing MNM events secondary to severe PPH at a tertiary care referral center. A retrospective analysis of 22 women fulfilling the World Health Organization (WHO) MNM criteria following severe PPH during the study period was conducted. Demographic details, obstetric characteristics, etiological factors, clinical presentation, interventions, and maternal outcomes were analyzed descriptively. The mean age of the women was 27.6±4.1 years. Atonic PPH was the most common etiology, accounting for 63.6% of cases, followed by traumatic PPH (22.7%) and retained placental tissue (13.6%). Hemorrhagic shock and severe anemia were common clinical severity indicators. Massive blood transfusion was required in 18 women (81.8%), uterine tamponade in 12 cases (54.5%), and surgical intervention in 6 cases (27.3%). All patients required intensive monitoring and multidisciplinary management, with intensive care unit admission in all cases. No maternal deaths were recorded, and the median duration of hospital stay was 8 days. The findings highlight that severe PPH continues to be a major contributor to MNM events, and favorable maternal outcomes depend on prompt recognition, timely referral, standardized PPH management protocols, availability of blood products, and coordinated multidisciplinary critical care.