Analysis of various criteria for identification of severe acute maternal morbidity in a rural tertiary health care centre: A prospective one year study

Abstract

Background: Maternal mortality has been the indicator of measurement of maternal health. Over the last decade, identification of severe acute maternal morbidity (SAMM) has emerged as a compliment or alternative to investigation of maternal deaths. A review of causes of SAMM will help to find out the potential problems which in turn will enable women to get the treatment on time. Recent researches have suggested that proper identification of SAMM cases can prove to be a better method to monitor the quality and effectiveness of obstetric care than mortality alone. Although there have been many criteria which have been introduced from time to time to identify these cases, because of vast variation of different level of facilities, these criteria cannot be applied across the regions. WHO has recently come up with certain set of criteria which could be more applicable to low resource settings. Aims & Objective: Present study tried to identify SAMM cases through various criteria and compared the applicability of them in our setup which is resource poor setting catering mainly to a huge rural population. Materials and Methods: It is a prospective study done over a period of one year, from September 2012 to August 2013. All severely morbid pregnant women or who had delivered or aborted within 42days were included. Initial identification of these cases was done on the basis of general criteria and later on other criteria were applied according to the primary obstetric event, clinical features, Lab findings or management provided. A comparison was done amongst all criteria and their individual applicability was checked as per the facility available in our set up. Results: During the study period total 7819 women delivered in the hospital out of which 6498 delivered vaginally and 1321 delivered through caesarian section. Total live births during this period were 5219. The present study found an incidence of severe maternal morbidity/near miss ranging from 5.56 to 40 per 1000 live births. Among 244 women suspected to be SAMM/MNM, 179(73%) met Waterstone's criteria, 48(20%) met Mantel's Criteria and 63(26%) met WHO criteria, 20% women met Mantel and Waterstone's criteria both while 17% met all three criteria. Conclusion: The study of SAMM cases and their identification through suitable criteria can contribute to know its magnitude, as well as to identify most frequent characteristics and clinical conditions which will help to recognize the problems in antenatal services, peripheral health care facilities and referral system. The criteria which are available now cannot be applied uniformly, and need to be tailored to identify more specific criteria according to infrastructure of a particular setting in order to utilize resources effectively.

A study to evaluate near miss obstetrics event and maternal deaths in tertiary care centre - Bikaner

“…Most of the women in both the groups never received antenatal care (82.4% patients in MNM group and 83% in MD group). This result is comparable from Kushwah et al in which 74% patients in near miss group never received ANC 14 . With proper antenatal care high risk pregnancy can be identified, treated or referred before they turn in to near miss condition or become maternal mortality.…”

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

“…In contrast, SMM is usually defined as a “near miss” episode characterized as the near death of a woman surviving pregnancy, or a childbirth-related complication, or within 42 days of the termination of pregnancy [ 4 , 5 ]. The true global burden of SMM is not known and thus poorly understood, primarily because of the lack of a standardized definition as well as, crucially, inconsistent recording and reporting of this outcome [ 1 , 6 , 7 , 8 ].…”

Severe acute maternal morbidity: study of epidemiology and risk factors

“…Hence, study and identification of SAMM cases gives an idea about its magnitude, to identify most frequent characteristics and clinical conditions which will help to recognize problems in antepartum services, peripheral health-care facilities and referral system. 12 It is believed that the underlying diseases causing SAMM are the same as those causing maternal death. If this proves to be true, then studying the circumstances surrounding a woman with SAMM will act as a complement to analysis of maternal mortality and will allow for a rapid assessment of maternal care.…”