Maternal Near-Miss and Maternal Mortality in a Tertiary Care Center of Western Uttar Pradesh: A Retrospective Study

Abstract

Introduction: Maternal mortality is an important indicator to assess the quality of services provided by the health care system. However, maternal near-misses as well as maternal mortality are also indicators of how well the health care system serves pregnant women. To improve our healthcare system in terms of investigative capacity, infrastructure, and personnel, a near-miss registry can provide important information on gaps in pregnancy facilities. This will help us to identify the requirements for referral facility improvements and the need for various health awareness programs. We, therefore, designed this study to analyze the various near-miss events in mothers and compare them with maternal mortality. Methods: Present study was conducted in the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (L.L.R.M.) Medical College associated with Sardar Vallabh Bhai Patel (S.V.B.P.) Hospital Meerut, Uttar Pradesh (UP), India for a period of one year and data were collected retrospectively from January 2022 to January 2023. All patients with life-threatening conditions such as excessive bleeding during pregnancy, hypertensive disorders of pregnancy (HDP), and septicemia that occurred during pregnancy or childbirth or within 42 days of termination of pregnancy and required ICU admissions, were included in the study. The total number of deliveries during the study period was 4,360 with 4,333 live births (LB). The total number of eligible cases was 79, out of which 52 were identified as maternal near misses and 27 were maternal mortality. Various maternal mortality and near-miss indices were analysed and statistical analysis was done using the SPSS version 21 (IBM Corp., Armonk, NY, USA). Results: Our hospital's maternal mortality ratio (MMR) was 623/1lakh (0.623%), which is higher than the probability due to the deficiency of appropriate medical services in the nearby areas of western UP. The number of maternal near misses per 1000 LB (maternal near-miss ratio [MNMR]) was 12/1000 LB and the severe maternal outcome rate (SMOR) was 18/1000 LB (1.82%). In our study, hemorrhage and hypertensive disorder in pregnancy were the leading cause of morbidity and mortality followed by sepsis and severe anemia. Among organ dysfunction cardiac illness followed by respiratory dysfunction was the leading cause of morbidity and mortality. Conclusion: It is clear that there is a high burden of maternal near-miss in developing countries. There should be the establishment of well-equipped referral units at the periphery with trained manpower. The establishment of obstetrical high-dependence units (HDUs), rapid availability of blood and blood products, training of staff, and availability of multidisciplinary teams can minimize maternal mortality and morbidity.