A study of maternal near miss cases at tertiary medical college of Jharkhand, India

Samarina Kamal, Priyankur Roy, Shashibala Singh, Jacinta Minz


Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth 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 selecting these cases.

Methods: The study was conducted in the Department of Obstetrics and Gynecology at RIMS, Ranchi, Jharkhand, India, which is a tertiary care centre. For each case of near miss, data were collected on demographic characteristics including gestational age at the time of sustaining the near-miss morbidity, nature of obstetric complications, presence of organ-system dysfunction/failure, ICU admission and timing of near-miss event with respect to admission.

Results: During the twenty-four months of the study period, 20000 deliveries at the institution and 480 women were identified as near-miss obstetrical cases by five factor scoring system. The prevalence of near-miss case in this study was 2.4%. Near-miss per 1000 delivery was 24%. Maternal death to near miss ratio was 1:7.2. The leading causes of maternal near miss were hemorrhage (42.5%) and hypertensive disorder of pregnancy (23.5%) The morbidity was high in unbooked cases.

Conclusions: Maternal near miss is good alternative indicator of health care system.


High dependency unit, Intensive care unit, Maternal near miss, Relaparotomy

Full Text:



Atrash HK, Alexander S, Berg CJ. Maternal mortality in developed countries. Not Just a concern of the past. Obstet Gynaecol. 1995;86:700-5.

Revised 1990 Estimates of Maternal Mortality a New Approach WHO and UNICEF. World Health Organization, Geneva, 1996.

Healthy pregnancy and childbearing. In: Tsui AO, Wasserheit JN and Haaga JG eds. Reproductive Health in Developing countries: Expanding Dimensions, Building solutions, Washington DC, National Academy press, 1997.

The progress of Nations. UNICEF, New York,1996.

Geller SE, Rosenberg D, Cox SM, Kilpatrick S. Defining a conceptual framework for near-miss maternal morbidity. J Am Med Womens Assoc. 2002;57(3):135-9.

Stones W, Lim W, Farook A, Kelly M. An investigation of maternal morbidity with the identification of life threatening “near-miss” episodes. Health trends. 1991;23:13-5.

WHO (2011)- Evaluating the quality of care for severe pregnancy complications: The WHO Near Miss Approach for maternal health. World Health Organization.

Geller SE, Rosenberg D, Cox S, Brown M, Simonson L, Kilpatrick S. (2004) A scoring system identified near-miss maternal morbidity during pregnancy. J Clin Epi. 57:716-20.

World Health Organization, UNICEF, UNFPA and The World Bank. Trends in maternal mortality: 1990 to 2008. Geneva: World Health Organization, 2010.

Say L, Souza JP, Pattinson RC. Maternal near miss- towards a standard tool for monitoring quality of maternal health care. Best Pract Res. 2009;23(3):287-96.

Mantel GD, Buchmann E, Rees H. Severe acute maternal morbidity. British J Obstet Gynaecol. 1998;105(9):985-90.

Waterstone M, Wolfe C, Bewley S. Incidence and pre-dictors of severe obstetric morbidity: case-control study. British Med J. 2001;322(7294):1089-93.

Lotufo FA, Parpinelli MA, Haddad SM, Surita FG. Applying the new concept of maternal near-miss in an intensive care unit, Clinics. 2012;67(3):225-30.

Roopa PS, 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.

Roosmalen VJ, Zwart J. Severe acute maternal morbidity in high-income countries. Best Prac 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(20):1-8.

Shrestha NS, Saha R, Karki C. Near miss maternal morbidity and maternal mortality. Kathmandu University. Med J. 2010;8(30):222-26.

Almerie Y, Almerie MQ, Matar HE, Shahrour Y. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria. BMC Pregnancy Childbirth. 2010;10:65-8.

Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: World Health Organization; 2011.

Cham M, Sundby J, Vangen S. Availability and quality of emergency obstetrics care in Gambia’s main referral hospital: Women-users’ testimonies. Reprod Health. 2009;6:5.

Minkauskiene M. Incidence/prevalence of severe maternal morbidity: A literature review. Geneva: Geneva Foundation for Medical Education and Research. Available at: http: www. gfmer. chEndoCourse2003Severe_maternal20morbidity_review. htm. 2003.

Bewley S, Creighton S. “Near-miss” obstetric enquiry. J Obstet Gynaecol (Paris). 1997;17:26-9.

Drife JO. Maternal near-miss reports? BMJ. 1993;307:1087-8.

Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute maternal morbidity: A pilot study of a definition for a near miss. Br. J obstet Gynaecol. 1998;105:985-90.

Prual A, Bouvier -Colle MH, De Bernis L, Breart G: Severe maternal morbidity from direct obstetric causes in West Africa: Incidence and case fatality rates Bull World Health Organ. 2000;78:593-602.

Baskett TF, Sternadel J. Maternal intensive care and near miss mortality in obstetrics Br. J obstet Gynacecol. 1998;105:981-4.

Murphy DJ, Charlett P. Cohort study of near miss maternal mortality and subsequent reproductive onteome. Eur J. obstet Gynaecol Reprod Biol. 2002;102:173-8.

Pattinson RC, Vandecruys HI, Macdonald AP, Mantel GD. Why do women die during childbirth. Science in Africa Available at: URL: http://www. scienceinafrica. co. za/2001/august/mothers. htm. 2001.

Ranatunga GA, Akbar JF, Samarathunga S, Perera YAG, Kariyawasam L, Kumarasiri JM. Severe acute maternal morbidity in a tertiary care institution. Sri Lanka J Obstet Gynaecol. 2012;34:135-43.

Nelissen EJ, Mduma E, Ersdal HL, Evjen-Olsen B, van Roosmalen JJ, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a crossectional study. BMC Pregnancy Childbirth. 2013;13:141.

Shrestha NS, Saha R, Karki C. Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J. 2010;8(2):222-6.

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):10-9.

Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231-43.

Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014;14:159.

Roopa PS, Verma S, Rai L, Kumar P, Murlidhar V, Pai, et al. “Near Miss” Obstetric Events and Maternal Deaths in a Tertiary Care Hospital: An Audit Journal of Pregnancy. (2013).

Jayaratnam S, Costa C D, Howat P. Developing an assessment tool for maternal morbidity ‘near-miss’– A prospective study in a large Australian regional hospital. Australian New Zealand J Obstet Gynaecol. 2011;51(5):421-5.