Maternal near miss events: a retrospective observational study in a tertiary care centre of central India

Ruchita Dadhich, Gita Guin, Sarika Rawat


Background: Clinically women who have survived complications during pregnancy and childbirth termed as Maternal Near Miss. The major reasons and causes are the same for both Maternal Near Miss and Maternal Death, so review of MNM cases is likely to yield valuable information regarding severe morbidity, which could lead to death of the mother, if not intervened properly and in time. Investigating the instances of severe morbidity may be less threatening to providers because the woman survived.

Methods: It was a retrospective study conducted at the Department of Obstetrics & Gynaecology NSCB Medical College Jabalpur, Madhya Pradesh, India. Data of maternal death and maternal near miss was collected from the previous records from 1st January 2017 to December 2017 according to WHO 2009 criteria.

Results: Total number of near miss cases was 164 and total number of Maternal Death was 111. Maternal Near Miss incidence ratio was 28.70 per 1000 live births. Maternal Near Miss to Maternal Mortality Ratio was 1.46 and Mortality index was 40.36%. Common cause of Near Miss events was hypertensive disorders of pregnancy - 85 cases (51.82%), followed by hemorrhage - 39 cases (23.78%). heart disease- 9 cases (5.48%) was also common during pregnancy.

Conclusions: In summary, this study shows that besides 111 cases who died, there were another 164 cases who survived due to the prompt diagnosis and treatment received in our set- up However, the overall high incidence of near-miss to maternal mortality (1.46) indicates that a significant proportion of critically ill patient still die of these complications. Maternal near miss reviews will be the best tool for the betterment of community and health care systems.


Fetal distress, Hypertension in pregnancy, Stillbirths

Full Text:



World Health Organization. Evaluating the quality of care for severe pregnancy complications -The WHO near- miss approach for maternal health. Geneva: World Health Organization; 2011. (2011). Census of India Website: Office of the Registrar General and Census Commissioner, India. [online] Available at: [Accessed 11 Apr. 2018].

Sustainable Development Goals (SDGs), Targets, CSS, Interventions, Nodal and other Ministries;

Government of Madhya Pradesh ; Department of Tribal Development ; HRMIS - Human Resource Management Information System.

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

Waterstone W, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity :case-control study. BMJ. 2001;322;1089-94.

Souza JPD, Duarte G, Basile Filho A. Near miss maternal mortality in developing countries. European Journal Obstetrics and Gynaecology Reprod. 2002;104:80.

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

Say L, Souza JP, Pattinsons RC. Maternal near miss- towards standard tool for monitoring quality of health care. Best Practice Clin Obst Gynecol. 2009;23:287-96.

Almerie Y, Almerie MQ, Matar HE, Shahrour Y, Chamat AA, Abdulsalam A. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study. BMC Pregnancy and Childbirth. 2010;10:65.

Nelissen EJT, Mduma E, Ersdal HL, Olsen BE, Roosmalen JJM, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross sectional study. BMC. 2013;13:141.

Roopa PS, Verma S, Rai L, Kumar P, Pai MC, Shetty J. Near miss obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregn.2013:393758.

Bansal M, Lagoo J, Pujari K. Study of near miss cases in obstetrics and maternal mortality in Bastar, Chhattisgarh, India. Int J Reprod Contracept Obstet Gynecol. 2016;5:620-3.

Yasmin G, Najam R, Ghazi S, Lalwani A. Maternal near miss events: a prospective observational study in a tertiary care centre Int J Reprod Contracept Obstet Gynecol. 2016;5:3088-93.

Sarma HKD, Sarma HK, Kalita AK. A prospective study of maternal near-miss and maternal mortality cases in FAAMCH, Barpeta; with special reference to its aetiology and management. J Obstet Gynaecol Barpeta. 2014;1:100-6.

Shrestha J, Shrestha R, Tuladhar R, Gurung S, Shrestha A. Maternal near miss in a tertiary care teaching hospital. American Journal of Public Health Research. 2015;3:17-22.

Mustafa R, Hashmi H. Near-miss obstetrical events and maternal death. J College Physians Surg Pakistan. 2009;19:781-5.

Purandare CN. Maternal near miss review: a way forward. J Obstet Gynaecol India. 2013;63:213-5.

Souza JPD, Cecatti TG. The near miss maternal morbidity scoring system was tested in a clinical setting in Brazil. J Clin Epidemiol. 2005;58:962-3.