A prospective study on maternal near miss cases at a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20196038Keywords:
Disorders, Hemorrhage, Hypertension, Maternal near missAbstract
Background: Pregnant women’s health status is not only reflected by mortality indicators alone hence the concept of Severe Acute Maternal Morbidity (SAMM) is appropriate for present health providing system. It helps to evaluate the quality of obstetric care in a particular institute. The main objectives of the study were to find a) Incidence of MNMM; b) Disorders underlying MNMM; c) Socio-demographic variables among MNMM; d) Facilities and skills needed to handle these near miss situations.
Methods: A prospective hospital-based study was conducted in the department of obstetrics and gynaecology, Gauhati Medical College and Hospital, Guwahati during the period 1st June 2018 to 31st May 2019. Cases were identified based on maternal near miss operational guidelines December 2014.
Results: Out of 16222 live births, 241 near miss cases were identified during the study. The maternal near miss incidence ratio is 14.86 per 1000 live births. The maternal near miss to maternal mortality ratio is 2.025. Most common cause of MNMM is hemorrhage (48.54%) followed by hypertension (19.5%), anemia (13.28%), sepsis (10.37%), cardiac dysfunction (6.2%), liver dysfunction (0.83%), renal dysfunction (0.83%) and respiratory dysfunction (0.41%).
Conclusions: The large magnitude of MNM cases may be attributed to improper management of obstetric emergencies at the referring hospitals, poor referral practices, inefficient transport system, limited availability of blood products and poor utilization of health care services at the peripheral hospitals. In our tertiary center, with the help of multidisciplinary action to all the near miss cases we can reduce maternal mortality to a great extent.
References
Nielsen HS, Eggebo TM. Millenium development goal 5- an obstetric challenge. Acta Obstetricia et Gynecologica Scandinavia. 2012;91(9):1007-8.
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.
Sivalingum N, Looi KW. Clinical experiences with management of near miss cases in Obstet Med J Malaysia. 1999;54(4):496-503.
World Health Organization- Evaluating the quality of care for severe pregnancy complications: The WHO near miss approach for maternal health. WHO; 2011.
Bansal M, Lagoo J, Pujari K. Study of near miss cases in obstetrics and maternal mortality in Bastar, Chhattisgarh, India. Int J Repro Contracept Obstet Gynaecol. 2016;5(3):620-3.
Behera R, Behera AA. Study on maternal mortality and near miss cases. J. Evid Based Med Healthc. 2017;4(93):5720-4.
Kamal S, Roy P Singh S, Minz J. A study on maternal near cases at tertiary medical college, Jharkhand, India. Int J Repro Contracept Obstet Gynaecol. 2017;6:2375-80.
Sahijwani DV, Desai A, Kansara V. Analysis of near miss cases as a reflection of emergency obstetric services and need of obstetric ICCU. J South Asian Feder Obst Gynae. 2013;5(3):99-101.
Sharma P, Jaiswal A. A critical analysis of determinants of maternal near cases at rural tertiary health centre. Global J Res Analy. 2017;6(2):2277-8160.
Shrestha J, Shrestha R, Tuladhar R, Gurung S, Shrestha A. Maternal near miss in a tertiary care teaching hospital. Am J Pub Health Res. 2015;3(5):17-22.
Reena RP, Radha KR. Factors associated with maternal near miss: a study from Kerala. Indian J Pub Health. 2018;62:58-60.
Anuradha J, Srinivas PJ, Manjubhashini S. A prospective study on maternal near miss cases in a tertiary care hospital in Vishakhapatnam. IOSR J Dent Med Sci. 2017;16(11):31-5.
Sujata P, Sahoo J, Rajkumari P, Sahoo G. Evaluation of obstetric near miss and maternal deaths in a tertiary care teaching hospital. Int J Recent Sci Res. 2016;7(2):9001-5.
