The New Indian Journal of OBGYN. Epub Ahead of Print

Study of maternal near miss cases at a tertiary centre in South India

Padmasri Ramalingappa, Raksha S Gowda, Shruthi Holavanahalli Srinivasamurthy

ABSTRACT

Background: Maternal mortality is a sentinel event to assess the quality of a women’s health care system. As the mortality rates are consistently decreasing the focus is shifted on maternal near miss which describes severe maternal morbidity which shares the common pathway as mortality. Objective: To assess and analyze the incidence of maternal near miss and the mortality indicators. Materials and methods: This is a retrospective descriptive study carried out in the department of obstetrics and gynaecology of a tertiary centre over six years. All women who fulfil the World Health Organisation (WHO) criteria of Maternal Near Miss (MNM) were included in the study. Relevant demographic and obstetric, further course and events leading to maternal near miss were studied. Finally the indices like maternal near miss incidence ratio, maternal near miss: maternal mortality ratio and mortality index were calculated. Results: During the six year study period, 21,692 deliveries took place at our institution and 539 women were identified as near-miss cases. The prevalence of near-miss case was 2.56%. Maternal near miss ratio was 25.66 per 1000 live births and maternal near miss to mortality ratio was 60:1. The leading medical co-morbidity causing maternal near miss was hypertensive disorder of pregnancy (47.1%) and the most common cause was obstetric hemorrhage in 77.1% cases. Majority of the cases (91.8%) were referral cases. Conclusion: The study of maternal near miss cases is a good indicator of our health care system. Emergency obstetric care training at the peripheries helps reduce the overall maternal morbidity and lessen the burden to health care system.