Evaluation of severe acute maternal morbidity and mortality at a tertiary referral center of Uttarakhand, India
Keywords:Live births, Maternal mortality, SAMM
Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.
Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.
Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).
Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication.
Social Statistics Division Ministry of Statistics and Programme Implementation Government of India. Millennium Development Goals India Country Report 2015. New Delhi; 2015;16-19.
WHO, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2013. Geneva: World Health Organization; 2014.
Kalra P, Kachhwaha CP. Obstetric near miss morbidity and maternal mortality in a Tertiary Care Centre in Western Rajasthan. Indian J Public Health. 2014;58(3):199.
Park K. Millennium development Goals to Sustainable development goals. Title: Parks textbook of preventive and social medicine.24th ed. Bombay: Banarasidas Bhanot; 2017.p 507.
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.
Paruk F, Moodley J. Severe obstetric morbidity. Curr Opin Obstet Gynecol. 2001;13(6):563-8.
Stones W, Lim W, Al-Azzawi F, Kelly M. An investigation of maternal morbidity with identification of life-threatening 'near miss' episodes. Health Trends. 1991;23(1):13-5.
WHO. Evaluating the quality of care for severe pregnancy complications: the WHO near miss approach for maternal health. World Health Organization 2011.
Rathod AD, Chavan RP, Bhagat V, Pajai S, Padmawar A, Thool P. Analysis of near-miss and maternal mortality at tertiary referral centre of rural India. J Obstet Gynecol India. 2016;66(S1):S295-300.
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(1):20.
Sample registration system Office of Registrar General. MMR bulletin 2010-12.; 2013. Available at http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf.
Souza JP. WHO Department of Reproductive Health and Research. Maternal Near Miss; Geneva 2011.
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. Journal of pregnancy. 2013;2013.
Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of Obstetric Near Miss and Maternal Deathsin a Tertiary Care Hospital in North India: Shifting Focus from Mortality to Morbidity. J Obstet Gynecol India. 2014; 64(6):394-9.
Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L, Say L. The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity. PloS one. 2012;7(8):e44129.
Gupta Sangeeta, Wadhwa Leena, Gupta Taru, Kumari Sushma. Evaluation of Severe Maternal Outcomes to Assess Quality of Maternal Health Care at a Tertiary Center. J Obstet Gynecol India. 2015; 65(1):23–7.
Adeoye IA, Onayade AA, Fatusi AO. Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study. BMC Pregnancy Childbirth. 2013;13(1):93.
Tunçalp Ö, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG: Int J Obstet Gynaecol. 2012;119(6):653-61.
World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Available at: http://apps.who.int/iris/bitstream/10665/ 44692/1/9789241502221_eng.pdf.