Maternal Near-Miss as a Surrogate Indicator of the Quality of Obstetric Care: A Study in a Tertiary Care Hospital in Eastern India

Abstract

Background Monitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health. Aim and objective The objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. Material and method This study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period. Results During the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission. Conclusion MNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.

Implementing the Who Near Miss Model to Assess Quality of Obstetric Care in a Tertiary Care Hospital

“…In the present study, the mean age of near-miss cases and maternal death are comparable to study of Kalra et al 13 . Our results are consistent with the study of Vinita Singh et al 14 who found maximum near misses in the 20-24 years of age group while the minimum number of women was in the age range of >35years.…”

Prevalence of Maternal Near-Miss and Maternal Mortality, Their Distribution by Gestation and Gravidity and Causes in Women With Live Births in District Peshawar, Pakistan

“…MMR was evaluated per 100,000 live births, whereas MNMR was evaluated using 1,000 live births as the denominator. Oladapo, et al 26 , and Akpan, et al 27 MM Ratio is reported lower than our study by Shaheen, et al 13 , Shahid, et al 15 , Aziz, et al 16 , Roopa, et al 19 , Singh, et al 20 , Kansara, et al 22 , Dhingra, et al 23 , Heemelaar, et al 25 , Chikadaya, et al 28 , David, et al 29 and Lotufo, et al 30 The caliber of maternal health care is illustrated by obstetric death. In our part of the world the near-misses are not usually used as a measure of the obstetric quality care as is also not used in many regions having increased MMR.…”

Prevalence and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis, 2015–2023

“…The pooled prevalence of maternal near miss from 13 studies (about 378,173 study participants) indicated 14% [95% CI: 8, 19]. This finding was greater than the global weighted pooled burden of maternal near misses [ 52 ], a study done in sub-Saharan Africa, Europe and Northern America [ 53 ], a study done in Tanzania [ 13 ], Latin America [ 54 ], Kenya [ 11 ], Harare, Namibia [ 55 ], Zimbabwe [ 56 ], South Africa [ 57 ], Eastern India [ 58 ] and Rwanda [ 59 ]. The reason for this variation could be the scope of the study, the year of publication, and the nature of the variation of MNM among high and low-income countries.…”