DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193149

A study on maternal near miss cases in Government Medical College Shivpuri, India

Uma Jain

Abstract


Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and causes of maternal near miss due to severe obstetric complications and to identify the gapes and contextualize corrective measures to be taken in our facility.

Methods: This is a retrospective study done in department of Obstetrics and Gynecology in GMC associated with DHS Shivpuri MP. The study was done during a period from 1st January 2018 to 30 April 2019.

Results: In this study the hospital maternal near miss incidence ratio was 14.34%. In our study we found the most common morbidity was (30.18%) hypertensive disorder of pregnancy. These 159 near miss diagnoses were comprised of (30.18 %) cases of Hypertensive disorder of pregnancy, (27.67%) cases of major obstetric hemorrhage, (6.91) Severe systemic infection or sepsis, (4.40%) Labour related disorders. In Medical disorders very Severe Anemia, (1.88%) was most common cause of near miss. The most common cause of death was post-partum hemorrhage 37.5% and most of the patients referred from periphery in very critical condition.  The median time taken to get clinical intervention among cases was 20-40 minutes after admission.

Conclusions: Hemorrhage and hypertension disorders are the leading causes of MNM. Prompt diagnosis and adequate management of near miss cases can reduce mortality rates.


Keywords


Hypertensive disorders, Maternal mortality, Obstetric hemorrhage, Severe acute maternal morbidity

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References


Kaur R, Roy D, Aggarwal P, Nautiyal R, Chaturvedi J, kakkar R. Application of WHO Near miss tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India: J Clin Diagn Res. 2016;10(1):LC10-3.

Pattinson RC, Say L, Souza JP, Broek NV, Rooney C. WHO Working Group on maternal Mortality and Morbidity Classifications. WHO maternal death and near miss classifications. Bull World Health Organ. 2009;87(10):734.

Tallapureddy S, Velagaleti R, Palutla H, Satti CV; “ Near Miss” Obstetric events and maternal mortality in a Tertiary Care Hospital; Indian J Public Health 2017 Oct- Dec; 61(4):350.

Aboubakr Elnashar; Behna University Hospital, Egypt, Maternal near miss – slideshare, 30 Oct 2018. Available at: http://www.slideshare.net.elnashar.

Mishra C.K. Maternal Near miss review operational guidelines. December 2014. Annexure 2: 35-40.

Sharma S, Aherwar R, Jawadhe S. Retrospective study of maternal near misses in a tertiary care instate: international Journal of Reproduction, contraception, Obstetrics and Gynecology. 2016;5(4)1114-8.

Kaur N, Aryal S. Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute: J. Lumbini Med. Coll. 2015;3(2):45-9.

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

Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JA, Vasconcelos MX. Incidence and main causes of severe maternal morbidity in Sáo Lusis, Maranháo, Brazil: A longitudinal study Sao Paulo Med J. 2011;129:146-52.

Sangeeta G, Leena W , Taru G , Sushma K , Nupur G , Amrita P , et al. Evaluation of severe maternal outcomes to assess quality of maternal health care at a tertiary center. J Obstet Gynaecol India 2015;65:23-7.

Chhabra P, Guleria K, Saini N, Anjur KT. Pattern of severe maternal morbidity in a tertiary hospital of Delhi, India: a pilot study. 2008;38(4):201-4.

Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case- control study. MBJ. 2001;322(7294):1089-4.

Upadhyaya I, Chaudhary P. Severe acute maternal morbidity and intensive care in Paropkar maternity and women’s hospital. NJOG. 2013;8(2):38-41.

Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JA, Vasconcelos MX. Incidence and main causes of severe maternal morbidity in Sao Luis Maranhao, Brazil: A longitudinal Study. Sao Paulo Med J. 2011;129(3):146-52.

Huseyin C, Cihan K, Ramzan A, Ziya YY, Murat E, Levent Y. Near miss obstetric cases: 4 years experience of a tertiary center. Gynecol Obstet Reprod Med. 2013;19(1):19-22.

Sauza JP, Cecatti JG, Parpinelli MA, Serruya SJ, AmaraI E. Appropriate criteria for identification of near miss maternal morbidity in tertiary care facilities: A cross sectional study BMC pregnancy and childbirth. 2007;7(1):20.

Taly A, Gupat S, Jain N. Maternal Intensive care and near miss mortality in obstetrics. J Obstet Gynecol India. 2004;54(5):478-82.

Roost M, Altamirano VC, Liljestrand J, Essen B. Priorities in emergency obstetric care in Bolivia - Maternal mortality and near miss morbidity in metropolitan La Paz. BJOG. 2009;116(9):1210-7.

Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post-partum: a multilevel analysis. The Lancet Global Health. 2018;6(5):e548-54.

Mehta M, BAvarva N. Facility base maternal Death Review at Tertiary care Hospital: A small Effort ot Explore Hidden facts. Appl Med Res. 2016;1(4):126-9.

Reena RP, Radha KR. Factors associated with maternal near miss: A study from Kerala. Indian J Public Health. 2018;62(1):58-60.

National program Implementation plan RCH Phase II- program document. Available at: http://mohfw.nic.in/NRHM/RCH/guidelines/PIP/RevIII.pdf. Accessed on 21 Feb 2012.

LaQshya: Labour room Quality Improvement Initiative In: National Health Mission; Ministry of Health & Family Welfare Government of India. 2017:03,12-14.