Near-miss Obstetric Events in a Tertiary Care Teaching Hospital in Nepal: An Audit

Gurung, BS; Koju, RB; Dongol, Yashad

doi:10.3126/njog.v10i1.13191

Cited by 3 publications

(7 citation statements)

References 13 publications

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“…The study suggested that the odds of developing maternal near-miss among women who had vaginal bleeding were 2.75 times more likely to develop life-threatening complication as compared to their counter parts. This report is supported with studies conducted in Nepal [10], southeast Iran [8], and Tigray, Ethiopia [12]. The possible explanation might be that women with excessive blood loss are more susceptible to shock with treatment regimens which often required blood transfusion.…”

Section: Discussionsupporting

confidence: 86%

“…Availability, accessibility, cost of health care, and behavioral factors play an important role in the utilization of maternal health services [2]. Maternal near-miss events were associated with postpartum hemorrhage, sever preeclampsia, eclampsia, sepsis or severe systematic infection, ruptured uterus, and septic abortion [9,10]. But in the current study, the main approaches to the reduction of maternal near-miss and maternal deaths are emergency obstetric care, skilled care by skilled birth attendants, and unmet obstetric need [2].…”

Section: Introductionmentioning

confidence: 99%

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Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

Asaye

2020

International Journal of Reproductive Medicine

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Background. Life-threatening situations might arise unexpectedly during pregnancy. Maternal near-miss can be a proxy for maternal death and explained as women who nearly died due to obstetric-related complications. It is recognized as the predictor of level of care and maternal death. Maternal near-miss evaluates life-threatening pregnancy-related complications, and it directs the assessment of the quality of obstetric care. Objective. To determine the proportion and factors associated with maternal near-miss at maternity wards at the University of Gondar Referral Hospital, Northwest Ethiopia, 2019. Methods. A cross-sectional study design was carried out from March 1 to June 20, 2019, using WHO criteria for maternal near-miss at the University of Gondar Referral Hospital. The data are from the interviews and review of 303 systematically selected participants’ medical files at maternity wards. Bivariate and multivariable logistic regression analyses were performed to analyze factors associated with maternal near-miss, including estimation of crude and adjusted odds ratios and their respective 95% confidence intervals and p value less than 0.05 through SPSS version 20. Result. The study revealed that the proportion of maternal near-miss was found to be 15.8% (95%CI=11.9%-20.1%). In the adjusted analyses, maternal near-miss was significantly associated with low (≤1000 ETB) monthly income (AOR=399; 95%CI=1.65, 9.65), seven or more days of hospital stay (AOR=5.43; 95%CI=2.49, 11.83), vaginal bleeding (AOR=2.75, 95%CI=1.17, 6.47), and pregnancy-induced hypertension (AOR=5.13; 95%CI=2.08, 12.6). Conclusion and Recommendation. The near-miss proportion was comparable to that in the region. Associated factors were low monthly income, seven or more days of hospital stay, vaginal bleeding, and pregnancy-induced hypertension. Thus, giving attention on early identification and treatment of these potential factors can be the opportunity in the reduction of maternal morbidity and mortality.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

Asaye

2020

International Journal of Reproductive Medicine

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“…Haemorrhage was identified as the most common aetiology of MNMs, followed by hypertensive disorders in pregnancy, consistent with other national and international literature 4–12,14,15,17 . However, unlike other studies, early pregnancy complications including miscarriages and ectopic pregnancies were the most significant contributors, while post‐partum haemorrhage (PPH) was reassuringly low among the ‘near misses’ in this study.…”

Section: Discussionsupporting

confidence: 88%

“…Within Nepal, there have been seven studies undertaken on MNM over the last ten years 8–14 . Five of these studies were undertaken at an institutional level, mostly at tertiary referral centres, while two were community‐based studies.…”

Section: Introductionmentioning

confidence: 99%

“…8 Within Nepal, there have been seven studies undertaken on MNM over the last ten years. [8][9][10][11][12][13][14] Five of these studies were undertaken at an institutional level, mostly at tertiary referral centres, while two were community-based studies. The majority of studies are descriptive in nature, with all but one utilising the World Health Organization (WHO) 'near miss' criteria to determine the level of maternal morbidity and mortality, identifying aetiologies of 'near miss' and evaluating quality of care using process indicators.…”

Section: Introductionmentioning

confidence: 99%

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Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility

Manandhar

Adhikari

Manandhar

et al. 2023

Aust NZ J Obst Gynaeco

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BackgroundThe World Health Organization (WHO) ‘near miss’ tool has been extensively used to audit maternal morbidity in low‐ and middle‐income countries. Analysis of the cases of ‘near miss’ enables a better understanding of the associated factors, identifies deficiencies in the provision of maternity services and lays a foundation for better preventive measures in the future.AimsTo understand the epidemiology, aetiology and determine the aspects of preventability of maternal ‘near miss’ (MNM) at Kathmandu Medical College.Materials and MethodsA prospective audit of MNM and maternal deaths (MD) was undertaken at Kathmandu Medical College over a period of 12 months. The cases were identified using WHO ‘near miss’ criteria and areas of preventability in the provision of care determined using the modified Geller's criteria.ResultsThe total number of deliveries and live births in the study period were 2747 and 2698 respectively. A total of 34 ‘near misses’ and two MDs were identified. The common direct aetiologies of MNM and MDs identified were obstetric haemorrhage followed by hypertensive disorders with one‐third of cases being of indirect aetiology. Fifty‐five percent of cases had some aspects of provider‐ or system‐related preventability with the leading delays being lack of diagnosis and recognition of high‐risk status among patients and lack of interdepartmental communication.ConclusionThe WHO near miss rate at Kathmandu Medical College was 12.5/100 live births. Significant aspects of preventability, especially at the level of the provider, were noted among cases of MNM and MDs.

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Prevalence and Risk Factors Associated with Maternal Near Miss Events in the Upper East Region of Ghana

Ofosu

2023

TIJAR

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A maternal near miss (MNM) event is a severe life-threatening maternal morbidity that reflects quality of obstetric care. It is considered a proxy of maternal mortality and predictor of quality obstetric care. The major underlying causes of MNM are hypertensive disorders, obstetric hemorrhage, sepsis and abortion complications. MNM is a more frequent event than maternal mortality and share several features together. Inquiries intodeficiencies andcritical assessment of health care quality, identify health system deficiencies, and help develop robust strategies for maternal care. We conducted a cross-sectional descriptive study to determine the prevalence and underlying causes of MNM. The study respondents were women aged 15 - 49 years with pregnancy experience in 2020 who had health facility care. Primary and secondary data were collected at households and health facilities respectively using electronic platform, KoBoCollect. STATA version 15.0 was used to analyze the data. The prevalence of MNM was 11.30%. The main underlying causes were complications of caesarean section, hypertensive disorders, anemia, obstructed labor, and antepartum hemorrhage. The main signal functions of emergency obstetric and newborn care (EmONC) employed to avert death were parenteral antibiotics, blood transfusion, caesarean section, and magnesium sulphate. The prevalence of MNM in the Upper East region was high. The region can reduce severe maternal morbidity and mortality by strengthening health systems, improving access to high-quality obstetric care and training healthcare providers to prevent and treat the major underlying causes of MNM identified in this study. Keywords: Ghana, MNM, Mortality, Prevalence, Antepartum, Hemorrhage, EmONC.

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Near-miss Obstetric Events in a Tertiary Care Teaching Hospital in Nepal: An Audit

Cited by 3 publications

References 13 publications

Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility

Prevalence and Risk Factors Associated with Maternal Near Miss Events in the Upper East Region of Ghana

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