Determinants of near miss mortality in a tertiary care centre

Abstract

Background: Near misses are defined as pregnant women with severe-life threatening conditions who nearly die but, with good care or good luck survive. Because near miss situation occurs more frequently than maternal death, more comprehensive and statistically reliable analysis could be conducted to assess the quality of maternal care and to develop evidence-based management protocols. The objectives of this study were to evaluate the determinants of near miss maternal mortality in a tertiary referral Government medical college hospital in Trivandrum, Kerala.Methods: Case control study from a defined delivery population with three randomly selected pregnant women as controls for every case. Study was conducted at Department of Obstetrics and Gynecology, Medical College Hospital Trivandrum, Kerala, India. Study duration was one year. Study population were patients admitted in Obstetrics and Gynecology Department, fulfilling the WHO criteria of near miss.Results: Of the primary determinant factors of near miss in this study, preeclampsia contributed the main role, followed by hemorrhage and eclampsia. During the antenatal period, preeclampsia was the major determinant followed by eclampsia. Hemorrhage was the major determinant in intra op /intra natal cases and next was eclampsia. Postpartum hemorrhage, eclampsia and preeclampsia were the major determinants in post-partum /post op cases. Among the associated indicators assessed, low socioeconomic status, anaemia, high body mass index, referral status, placenta praevia and caesarean section were statistically significant.Conclusions: Detailed analysis of near miss cases helps in identifying risk factors. It helps in formulating preventive strategies, and helps us in tackling the delays in referral process.

The magnitude of maternal near-miss cases in public hospitals of Hadiya zone, southern Ethiopia

“…This study was based on an adapted sub-Saharan Africa MNM tool for MNM cases detection and accordingly, the most common near-miss event was severe pre-eclampsia followed by sepsis and severe PPH. Our study was in line with studies conducted in India, Syria, South Africa, and Egypt where severe pre-eclampsia is the most common MNM event [19][20][21][22]. But it was different from a study conducted in the Amhara region of Ethiopia where a ruptured uterus was the most common MNM event followed by severe pre-eclampsia and severe postpartum haemorrhage [23].…”

Determinants of maternal near miss events: a facility based case-control study

“…Based on the previous study, the proportion of hypertensives among cases and controls were 53.6% and 22.1% respectively. 6 Considering alpha error of 5% and 80% power of the test with 1:2 ratio for cases and controls, the Final sample size was 82, of which 27 were cases and 55 were controls between April to May 2018.…”

“…5 The 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". 6 In practical terms, women are considered near-miss cases when they survive lifethreatening conditions (i.e. organ dysfunction).…”