A study of maternal near miss at a district teaching hospital: a retrospective observational study

Manjunatha S., Harsha T. N., Damayanthi H. R.


Background: Maternal health is an integral part of health care system. Maternal mortality is an indicator of maternal health and health care delivery system. Severe morbid conditions require comprehensive approach. Hence the concept of Maternal Near Miss (MNM) has emerged. The data of maternal near miss helps to reduce the maternal death and helps to achieve the goals related to reduce the maternal mortality rate of the country as well as the world and to improve the quality of life of the woman population by a quality care. Objectives of present study were to identify and analyze the strategies undertaken in the management of maternal near miss and outcome, measures to improve the quality of care and to assess the various indicators of MNM.

Methods: With the permission from the hospital administrators and after taking the ethical clearance from the institutional ethical committee, a retrospective observational study was conducted for the period of one year between January 2016 to December 2016 at district teaching hospital of Kodagu Institute of Medical Sciences, Madikeri, by collecting data from hospital records. Admissions to the ICU as well as wards which fit in to the WHO maternal near miss criteria were included and studied.

Results: WHO criteria for the MNM was followed. In present study, there were 25 MNM cases and four Maternal Deaths out of 3347 live births giving a maternal mortality ratio of 119/100000 live births (LB), Maternal Near Miss ratio of 7.46/1000LB, MNM:1MD ratio is 6.25 and mortality index (MI) is 13.79%. Twenty five cases of obstetric emergencies with serious concerns for maternal health were selected out of 97 cases who met the WHO criteria for MNM (25.77%). Twelve cases (48%) received multiple blood-transfusions, 8 cases (32%) of sepsis, 7 (28%) of PPH, and 5 (20%) of hypertensive disorder of pregnancy (pre-eclampsia, eclampsia). There were 12 cases (48%) that had more than one inclusion criteria. Surgical intervention was required in 8 (32%) i.e. 2 peripartum hysterectomies, 2 laparotomies, 1 manual removal of placenta, 1 uterine reposition and 2 traumatic PPH repair.

Conclusions: Maternal-Near-Miss (MNM/SAMM) and its relation to maternal mortality contribute as sensitive measures of pregnancy outcome than mortality alone. Proper documentation is of paramount importance in analysis of data, to make conclusions and recommendation. Prospective structured study is required to get a clear picture and to suggest corrective measures which can be taken as far as obstetric care is concerned, to reduce maternal mortality and to achieve the sustainable developmental Goal (SDG) of maternal mortality ratio <70/100000 LB by 2030.


Maternal Near Miss, Maternal Mortality, Severe Acute Maternal Morbidity.

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WHO. World Health Statistics 2014. Fact Sheets. Geneva: World Health Organization; 2009 and 2014. Available at

National Technical Group(NTG), NHM (MOHFW) GOI. 2013-14. Available at

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

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.

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

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.

7Pattinson RC, Vandecruys HI, Macdonald AP, Mantel GD Why do women die during childbirth 2001. Available at http: // www. Scienceinafrica.

Sahel A, Brouwere VD, Lardi M, Lerberghe WV, Ronsmans C, Filippi V. Obstetric catastrophies barely just avoided: near misses in Moroccan hospital. Sante. 2001;11:229-35.

Yelikar KA, Deshpande SS, Deshmukh SF. Study of severe acute maternal morbidity in tertiary care centre. Int J Scient Study. 2015;3(5):36-40.

Siddiqui SA, Soomro N, Shabih-ul-Hasnain F. Severe obstetric morbidity and its outcome in patients presenting in a tertiary care hospital of Karachi. J Pak Med Assoc. 2012;62:226-31

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 Sergipe, Northeast Brazil. BMC Pregnancy Childbirth. 2014;14:25

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.

Huseyin C, Cihan K, Ramazan A, Ziya YY, Murat E, Levent Y. Near miss obstetric cases: 4 years experience of a tertiary center. Gynecol Obstet Reprod Med. 2013;19:19-22.

Upadhyaya I, Chaudhary P. Severe acute maternal morbidity and intensive care in Paropkar maternity and women’s hospital. NJOG. 2013;8:38-41.