A study to assess proportion of the maternal near miss to maternal death in a tertiary care teaching hospital of North East India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20202334Keywords:
Audit of maternal near miss, Maternal death, Maternal near miss, Obstetric intensive care unit, SevereAbstract
Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.
Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.
Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).
Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
References
Pattinson R, Say L, Souza JP, van den Broek N, Rooney C. WHO maternal death and near-miss classifications. Bull World Health Organ. 2009;87:734.
Costello A, Azad K, Barnett S. An alternative strategy to reduce maternal mortality. Lancet. 2006;368:1477-9.
Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231-43.
Prual A, Bouvier-Colle MH, de Bernis L, Bréart G. Severe maternal morbidity from direct obstetric causes in West Africa: Incidence and case fatality rates. Bull World Health Org. 2000;78:593-602.
Say L, Pattinson RC, Gulmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.
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.
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. J Preg. 2013;2013.
Reena RP, Radha KR. Factors associated with maternal near miss: A study from Kerala. Indian J Pub Health. 2018;62(1):58.
Ghazal-Aswad S, Badrinath P, Sidky I, Safi TH, Gargash H, Abdul-Razak Y, et al. Severe acute maternal morbidity in a high-income developing multi-ethnic country. Mat Child Health J. 2013;17(3):399-404.
Donati S, Senatore S, Ronconi A, Regional Maternal Mortality Working G. Obstetric near-miss cases among women admitted to intensive care units in Italy. Acta Obstet Gynecol Scand. 2012;91(4):452-7.
Zanconato G, Cavaliere E, Iacovella C, Vassanelli A, Schweiger V, Cipriani S, et al. Severe maternal morbidity in a tertiary care centre of northern Italy: a 5-year review. The J Maternal-Fetal Neonat Med. 2012;25(7):1025-8.
Wilson RE, Salihu HM. The paradox of obstetric "near misses": converting maternal mortality into morbidity. Int J Fertil Womens Med. 2007;52(2-3):121-7.
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 Preg Childbirth. 2013;13:93.
Nelissen EJT, Mduma E, Ersdal HL, Evjen-Olsen B, Roosmalen JJM, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study. BMC Preg Childbirth. 2013;13(1):141.
van den Akker T, van Rhenen J, Mwagomba B, Lommerse K, Vinkhumbo S, van Roosmalen J. Reduction of severe acute maternal morbidity and maternal mortality in Thyolo District, Malawi: the impact of obstetric audit. PLoS One. 2011;6(6):20776.
Gebrehiwot Y, Tewolde BT. Improving maternity care in Ethiopia through facility-based review of maternal deaths and near misses. Int J Gynecol Obstet. 2014;127:S29-S34.
Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near-miss in a rural hospital in Sudan. BMC Preg Childbirth. 2011;11(1):48.
Chandran JR, Raj SV, Devi SD. Maternal near miss reviews from a tertiary care center in South India. Int J Reprod Contracept Obstate Gynecol. 2016;5(8):2657-60.
