Evaluation of Obstetric Near Miss and Maternal Deaths in a Tertiary Care Hospital in North India: Shifting Focus from Mortality to Morbidity

Abstract

Objective Near miss audit improves understanding of determinants of maternal morbidity and mortality and identifies areas of substandard care. It helps health professionals to revise obstetric policies and practices. Methods A retrospective review of obstetric case records was performed to assess frequency ad nature of maternal near miss (MNM) cases as per WHO criteria. For each case, primary obstetric complication leading to maternal morbidity was evaluated. Obstetric complications were analyzed to calculate prevalence ratio, case fatality ratio, and mortality index.Results There were 6,357 deliveries, 5,273 live births, 247 maternal deaths, and 633 MNM cases. As per WHO criteria for Near miss, shock, bilirubin [6 mg%, and use of vasoactive drugs were the commonest clinical, laboratory, and management parameters. Hemorrhage and hypertensive disorders of pregnancy were leading cause of MNM (45.7 and 24.2 %) and maternal deaths (28.7 and 21.5 %). Highest prevalence rate, case fatality ratio, and mortality index were found in hemorrhage (0.53), respiratory diseases (0.46), and liver disorders (51.9 %), respectively. Conclusion Developing countries carry a high burden of maternal mortality and morbidity which may be attributed to improper management of obstetric emergencies at referring hospitals, poor referral practices, and poor access/ utilization of health care services.

Maternal near miss in low‐resource areas

“…WHO also developed a tool to classify near miss . Subsequently, numerous studies have used these criteria to define near miss worldwide …”

“…3,4 Subsequently, numerous studies have used these criteria to define near miss worldwide. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The WHO near-miss criteria were primarily designed for hospital settings under the assumption that these conditions usually result in maternal death when they occur outside the health facility. 4 However, numerous adaptations have been used across studies and in different settings.…”

“…4 However, numerous adaptations have been used across studies and in different settings. Depending on the geographic location, population, and specific details of the classification, studies of maternal near miss in low-and middle-income countries (LMICs) report frequencies ranging from less than 1% to more than 15% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). Almost all studies have been conducted in health facilities, ranging from tertiary referral hospitals to maternity care centers.…”

Severe acute maternal morbidity: study of epidemiology and risk factors

“…improper management of obstetric emergencies at referring hospitals, poor referral practices, and poor access or utilization of health care services. 13 This idea of substandard care can suggest changes in clinical education programmes and policies to improve maternal outcome. 14 Besides, continuous psychosocial follow up of those survived is necessary as their longterm health-related quality of life is impaired.…”

A study of maternal near miss cases in tertiary health centre in north India

“…Table 4 shows a comparison of clinical criteria for identification of maternal near miss cases. 4,10 Study by Brace et al reported loss of consciousness >12 hours in 13% cases, shock in 3% cases, clotting failure in 7.74%, gasping in 8%, respiratory rate <6/min or >40/min in 9% cases, oliguria in 10% and jaundice in presence of preeclampsia in 2.3% cases. Das et al reported loss of consciousness in 18.7% cases, shock in 53%, clotting failure in 4%, gasping in 8% cases, respiratory rate problems in 17.7%, oliguria in 11.8% and jaundice in presence of preeclampsia in 3.6% cases.…”