Retrospective review of maternal deaths and maternal near misses due to major obstetric haemorrhage at a tertiary care centre in India

Abstract

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution. Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital over a period of 12 months (April 2016-March 2017), of all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH). Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was 2.46. Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively. It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor for the morbidity of the patient. Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH.

Retrospective analysis of maternal mortality: a paradigm shift from 2010 to 2020

“…The second most common indirect cause of deaths in present study was haemorrhage 20% which was similar to study by Agarwal et al 14 Several publications have documented an increase in the incidence of obstetric haemorrhage particularly PPH over the recent years. It is important to identify the causative factors for obstetrical haemorrhage so that remedial measures can be taken to reduce their occurrence or severity.…”

Pattern of utilization of blood and blood components in obstetrics at a tertiary care center: a cross-sectional study

“…Among other studies, Agrawal et al reported that the mode of delivery was vaginal in 21% of cases and caesarean in 79% of cases. 16 Most of the women were delivered by caesarean section (58.56%) in the study by Renuka et al 17 Similarly in study by Chowdhury et al 63.92% had caesarean section. 15 In Thurn et al 5.7% cases had caesarean deliveries.…”

“…Among other studies, Agarwal et al reported that the number of maternal deaths occurring amongst all women with massive obstetric haemorrhage was 3.33%. 16 No mortality was reported by Chawla et al, Vaid et al and Renuka et al 17,18,25…”

“…Among other studies, in the study by Agrawal et al majority (54%) of the patients were para 2 or more. 16 Renuka et al reported that 58.37% women were multigravida and Chowdhury et al reported that 68.35% women were multiparous. 15,17…”

“…Among other studies, Agrawal et al reported that mean age of the patients was 27.4 years. In the study by Renuka et al 70.16 % women were in the age group of 21 to 30 years 16,17. Vaid et al reported mean age of 27.7 years 18.…”