Maternal near miss: an Indian tertiary care centre audit


  • Padmaja Y. Samant Department of Obstetrics and Gynecology, Seth GS Medical college and KEM Hospital, Parel, Mumbai, Maharashtra, India
  • Juhi Dhanawat Department of Obstetrics and Gynecology, Seth GS Medical college and KEM Hospital, Parel, Mumbai, Maharashtra, India



Audit, Maternal near-miss, Preeclampsia, Severe acute maternal morbidity


Background: In practical terms, women are considered near-miss cases when they survive conditions which threaten their life i.e. organ dysfunction. Despite advances in medical science and increased awareness of measures for safe childbirth, unacceptably high maternal morbidity and mortality continues to plague developing countries like India. Our’s being a tertiary care centre, draws a lot number of high-risk patients and referrals. By auditing these near miss cases, we aim to identify the causes, factors leading to near miss, to identify management gaps to prevent near misses and maternal death.

Methods: Retro-prospective cross-sectional study done over one and a half year. Patients were included based on the inclusion criteria. A questionnaire was used to evaluate the prospective cases and the indoor case sheets were used for retrospective cases. After data entry in excel sheet, data analysis was done using SPSS 21. Results were tabulated.

Results: High number of Near Miss cases with preeclampsia being the commonest. Lack of proper facilities at the periphery health centers was the most common cause for referrals. Level 1 and level 2 delays were found in most cases.

Conclusions: Timely referral, with adequate treatment at the peripheral hospitals will majorly reduce Near miss. Hence, proper development and functioning of peripheral hospitals are needed.


Tuncalp O, Hindin M, Souza J, Chou D, Say L. The prevalence of maternal near miss: a systematic review. British J Obstet Gynecol. 2012;119(6):635-61.

Taly A, Gupta S, Jain N. Maternal intensive care and near miss mortality in obstetrics. J Obstet Gynecol Indsep. 2004;54:478-82.

Jayaratnam S, De costa C, Hernet P. Developing an assessment tool for maternal morbidity near miss- a prospective study in a large Australian regional hospital. Aus New Zealand J Obstet Gynecol. 2011;51:421-5.

National Health Mission; Maternal near miss review operational guidelines; December 2014. Available at:

Naderi T, Foroodnia S, Omidi S, Samadani F, Nakhaee N. Incidence and correlates of maternal near miss in southeast Iran. Int J Reprod Med. 2015;2015:914713.

Gupta SK, Pal DK, Tiwari R, Garg R, Shrivastava AK, Sarawagi R, et al. Impact of JananiSurakshaYojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India. J Health Popul Nutr. 2012;30:464-1.

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

Sousa M, Cecatti J, Hardy E, Serruya S. Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance. Reproductive Health. 2008;5(1):article6.

Brace V, Penney G, Hall M. Quantifying severe maternal morbidity: a Scottish population study. BJOG. 2004;111(5):481-4.

Souze JP, Cecath JG, Faundes A, Morais SS, Villai J, Caroli G, et al. Maternal near miss and maternal death in the World Health Organisation 2005 global survey on maternal and perinatal health. Bull World Heal Org. 2010;88:113-9.

Almerie Y, Almerie MQ, Matar HE, Shahrour Y, Al Chamat AA, Abdulsalam A. Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study. BMC Pregnancy Childbirth. 2010;10(1):65.

Shrestha N, Saha R, Karki C. Near miss maternal morbidity and maternal mortality at Kathmandu Teaching Hospital, Kathmandu univ. Med J (KUMJ). 2010;8:222-6.

Prual A, Huguet D, Garbin O, Rabe G. Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger). Afr J Reprod Health. 1998;2(1):10-9.

Roosmalen JV, Zwart J. Severe acute maternal morbidity in high-income countries. Best Practice and Research: Clin Obstet Gynecol. 2009;23(3):297-304.

Mustafa R, Hashmi H. Near-miss obstetrical events and maternal death. J Coll Physcians Surg Pak. 2009;19(12):781-5.

Purandare C, Bhardwaj A, Malhotra M, Bhushan H, Chhabra S, Shivkumar P. Maternal near-miss reviews: lessons from a pilot programme in India. BJOG. 2014;121:105-11.

Sarma H, Kalita A. A prospective study of maternal near-miss and maternal mortality cases in FAAMCH, Barpeta with special reference to its aetiology and management: First 4 months report. J Obs Gynaecol Barpeta. 2014;1(2).

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: A systematic review. Lancet. 2006;367:1066-74.

Kalra P, Kachhwala C. Obstetric near miss morbidity and maternal mortality in a tertiary care centre in western Rajasthan. Ind J Pub Heal. 2014;58(3).

Bindal J, Solanki G. Clinical and etiological study of maternal near-miss at a tertiary referral hospital of Central India. Ind J Obstet Gynaecol Res. 2016;3(1):28-31.

Rööst M, Altamirano VC, Liljestrand J, Essén B. Priorities in emergency obstetric care in Bolivia - Maternal mortality and near? miss morbidity in metropolitan La Paz. BJOG. 2009;116:1210-7.

Goffman D, Madden RC, Harrison EA, Merkatz IR, Chazotte C. Predictors of maternal mortality and near-miss maternal morbidity. J Perinatol. 2007;27:597-601.

Rööst M, Jonsson C, Liljestrand J, Essén B. Social differentiation and embodied dispositions: a qualitative study of maternal care seeking behaviour for near miss morbidity in Bolivia. Reprod Health. 2009;6:13.

Sunil TS, Rajaram S, Zottarelli LK. Do individual and program factors matter in the utilization of maternal care services in rural India? a theoretical approach. Soc Sci Med. 2006;62:1943-57.

Saving Mothers’ Lives: what works. White Ribbon Alliance/India. 2002:99.

Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: A case study. J Health Popul Nutr. 2009;27:184-201.

Oladapo O, OSule A. “Near miss” obstetric events and maternal near deaths in Sagamu, Nigeria: a retrospective study. Reproductive Health. 2005;2:9.

Gandhi MN, Welz T, Ronsmans C. Severe acute maternal morbidity in rural South Africa. Int J Gynecol Obstet. 2004;87:180-7.

Rulisa S, Umuziranenge I, Small M, van Roosmalen J. Maternal near miss and mortality in a tertiary care hospital in Rwanda. BMC Pregnancy Childbirth. 2015;15(1):203.






Original Research Articles