Severe acute maternal morbidity: study of epidemiology and risk factors

Sinha, Manish Kumar; Goel, Jai Kishan; Sah, Shanti; Goel, Ruchica; Chaurasia, Rajani

doi:10.18203/2320-1770.ijrcog20162080

Cited by 4 publications

(3 citation statements)

References 9 publications

(11 reference statements)

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“…The mean age and the age group were almost similar to the study by Sinha et al 6 Though teenage pregnancy has come down in number, pregnancy and its complications are yet more seen in early 20s. Hence education to women, motivation to avoid child marriage, providing knowledge to teenagers regarding contraception should be encouraged.…”

Section: Discussionsupporting

confidence: 85%

A study of maternal and fetal outcomes in critically ill obstetric patients

Tasneem

Sharma

2020

Int J Reprod Contracept Obstet Gynecol

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Background: Pregnancy related morbidity is becoming a nightmare in Indian women. Some of these women end up in mortality and a few of them narrowly escape death. Critical care should be and is an authenticated part of obstetric practice. This study is an effort initiated to understand the risk of maternal morbidity, to investigate the contributing factors, foetal outcome, to study the adverse event, cause of maternal death and remedial measures. Methods: All the obstetric cases admitted in Intensive care unit in a government institute in Maharashtra during January 2018 to June 2019 were analyzed prospectively. The indications for transfer into intensive care, risk factors, co morbidities if any were studied. Maternal and fetal morbidity and mortality were included in the study. Results: During the study period, there were 10, 208 deliveries. There were 12 maternal deaths and 98 critically ill patients became morbid. Anemia is found to be a major pre-existing contributing factor (25.5%) and an important risk factor making pregnancy become critical. DIC is found to be a major reason for ICU admission (39.1%), 72.7% needed mechanical ventilator and 60.1% needed ionotropic support. Conclusions: Anemia is a major problem still existing in our country. Gestational hypertension is another leading cause of critical illness in pregnancy. Identification of patients who are going downhill, timely referral to higher centers and appropriate management can improve both the maternal and the fetal outcomes.

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Section: Discussionsupporting

confidence: 85%

A study of maternal and fetal outcomes in critically ill obstetric patients

Tasneem

Sharma

2020

Int J Reprod Contracept Obstet Gynecol

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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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“…Worldwide maternal mortality is the most commonly used indicator to assess the quality of prevailing maternal health care services but over the last decade identification of severe acute maternal morbidity (SAMM) has emerged as a compliment or alternative to investigation of maternal deaths. 2 Morbidity during pregnancy represents a continuum between extremes of good health and death which can be uncomplicated, complicated, www.jmscr.igmpublication.org Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.114 severely complicated or life threatening and a woman may recover, may be temporarily or permanently disabled or she may die. WHO defines "SAMM as a woman who nearly died but survived a complication that occurred during pregnancy, child birth or within 42 days of termination of pregnancy".…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of severe acute maternal morbidity of obstetric ICU in Kamla Raja Hospital, Gwalior

Deepika¹

2019

jmscr

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Introduction: Critically ill obstetrics patients represent an interesting group with unique characteristics whose management is challenged by the presence of a fetus an altered maternal physiology and disease specific to pregnancy. Although pregnancy and labour are considered physiological processes, the potential for catastrophic complications is constant and may develop within minutes. To every maternal death, there are about 18 maternal morbidities and maternal mortality and morbidity are a measure of health care quality indices in any given community. Objectives: 1. To find out the incidence of SAMM. 2. To study outcome of obstetric ICU admitted patients. Methods: Hospital files of all obstetric patients admitted to the Kamla Raja Hospital ICU from 2017 to 2018 were retrospectively reviewed. Age, parity, admission, diagnosis, length of stay, information on the referring hospitals and maternal outcome were analysed. Result: Total 1713 obstetric patients were admitted in the ICU during the study period. Hypertensive disorder of the pregnancy was the commonest cause for ICU admission. Maximum no. of SAMM cases 113(44.84%) were in 20-30 years. Maximum no. of SAMM cases were multigravida 166(65.87%). Out of total 252 cases 156(61.9%) cases were unbooked. In this study, LSCS as surgical management in 190(75.39%) cases followed by laparotomy 13(5.138%). Conclusion: Provision of HDU in the Obstetric Department is helpful to reduce burden of ICU admission. All obstetric residents should have a mandatory short ICU training.

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Severe acute maternal morbidity: study of epidemiology and risk factors

Cited by 4 publications

References 9 publications

A study of maternal and fetal outcomes in critically ill obstetric patients

A study of maternal and fetal outcomes in critically ill obstetric patients

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

Retrospective analysis of severe acute maternal morbidity of obstetric ICU in Kamla Raja Hospital, Gwalior

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