Publication:

Maternal near miss events: a prospective observational study in a tertiary care centre

Background A maternal near miss case is defined as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. In 2009, World Health Organization (WHO) has developed new system based on organ system dysfunction which incorporates clinical, laboratory and management based criteria for identifying maternal near miss. Fortunately, most of the obstetrical complications can be prevented or managed provided a timely and proper intervention is taken. Hence, this study was conducted with the objectives to determine the frequency, to study the demographic characteristics, causes, interventions and feto- maternal outcome of the maternal near miss cases.

Methods A prospective observational study was conducted in Teerthanker Mahaveer Medical College and research Centre, Moradabad, Uttar Pradesh from July 2015 to June 2016. All patients according to WHO inclusion criteria for maternal near miss were included in the study. All relevant data were collected on the pre-designed proforma in details regarding age, parity, gestational age, causes, interventions taken, feto-maternal outcome.

Results Total number of near miss cases were 122, maternal near- miss incidence ratio was 45.2 per 1000 live births. Most of the cases of maternal near- miss in this study were in the age group of 20-35 years (71.3%), multipara (61.5), in the third trimester. Most common cause for maternal near- miss in the present study was found to be hemorrhage (44.3%) followed by hypertensive disorders of pregnancy (HDP) 34.4% followed by dystocia (14.8%), sepsis (2.4%) and anemia (4.1%). Neurological dysfunction (10.7%) was the most common organ dysfunction. Nearly 42.6% near- miss admissions were delivered by LSCS, 48.4% were live births and 28.7% were still births.

Conclusions This study concludes hemorrhage and hypertensive disorders to be the leading causes for maternal near miss. Hence evaluation of the circumstances surrounding near-miss can give us an idea to know the exact etiology, treat it in its early stage and prevent death.