“Near-Miss” Obstetric Events and Maternal Deaths in a Rural Tertiary Care Center in North India

Verma, Vandana; Kanti, Vaibhav; Vishwakarma, Soniya; Gupta, Umesh Kumar; Shree, Pragya

doi:10.7759/cureus.11828

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Both MNMR and SMOR give an estimate of the amount of care and resources that would be needed to improve obstetric care in that area or facility. We reviewed studies done in different parts of India, and the near-miss ratio ranged from 120 to 10.4 ( Table 12) [10][11][12][13][14][15][16][17][18][19][20][21][22]. However, all these studies have used different criteria in identifying near-miss cases and hence technically not ideal for comparison.…”

Section: Discussionmentioning

confidence: 99%

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

Singh¹,

Barik²

2021

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

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

Singh¹,

Barik²

2021

Cureus

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“…10 Studies from Karachi and neighbouring country India showed maternal near-miss rate was around 16.6 to 31.4 per 1000 live births. 14,15 Multiple factors may be responsible for these increased figures, including hospital setting and geographical location.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Various Factors Associated with Maternal Near Miss in Karachi Sindh

Subuktageen

Raja

Subuktageen

et al. 2022

PAFMJ

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Objective: To determine the factors associated with maternal near-miss in booked patients managed at tertiary care hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Malir Cantt from Jun 2019 to Jul 2021. Methodology: A total of 198 pregnant women of were included in the study. All the women were followed until delivery, and data was collected for near maternal miss and types of complications. Relationship of the age of study participants, gestation, parity and presence of comorbid medical illnesses were analysed with maternal near-miss in our study participants. Results: Out of 198 pregnant women included in the study, 168 (84.8%) did not have near-miss, while 30 (15.2%) had experienced at least one near-miss. The mean age of the women included in our study was 29.236 ± 2.45 years. Cardiovascular complications 14 (7.1%) were the most common in our study participants, followed by renal complications 8 (4.1%). The second and third trimesters and the presence of medical comorbidities were statistically significantly associated with nearmiss (p-value <0.05). Conclusion: Near miss was a fairly common finding in booked pregnancies managed at our hospital. Women in the second or third trimester of pregnancy and those with any medical conditions had more chances of having near-miss than those in the first trimester or without any medical comorbidities.

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

Verma¹,

Choudhary²,

Chaudhary³

et al. 2023

Cureus

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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.

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“Near-Miss” Obstetric Events and Maternal Deaths in a Rural Tertiary Care Center in North India

Cited by 3 publications

References 9 publications

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

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

Analysis of Various Factors Associated with Maternal Near Miss in Karachi Sindh

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

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