Maternal near miss in a tertiary care hospital: A retrospective and prospective observational study

Abstract

: Maternal mortality is an indicator of the quality of maternal health services provided in the country. Despite the therapeutic advances in obstetric care and growing perception of the safety of childbirth over the past few decades, maternal morbidity and mortality remain to be a challenge in developing countries like ours where little attention has been given to the near miss obstetric events. : To study the prevalence and clinical profile of Maternal near miss in a tertiary care center.: To evaluate the underlying disorders, contributory factors and socio-demographic variables among maternal near miss cases.: This observational study was undertaken at the Department of Obstetrics and Gynecology, Maulana Azad Medical College (MAMC) & associated Lok Nayak Hospital (LNH), New Delhi for a period of one year. The study population was the patients attending OPD or casualty or admitted in the Department of Obstetrics and Gynecology at LNH, MAMC, who fulfilled the MoHFW maternal near miss identifying criteria and whose case records were available. The data for the study was collected both retrospectively and prospectively from January 2019 to December 2021. Detailed history of patients like name, age, date of admission and presenting complaints were recorded. Obstetric history including history of previous pregnancy and labor, complications during present pregnancy, past and present medical problems were also recorded. For each case of MNM, the primary obstetric complication leading to near miss was evaluated.: There were 7064 live births during the study period. The study reveals a near miss ratio of 3.25 per 1000 live births. The near miss to mortality ratio was found to be 0.38:1 and the mortality index was 71.95%. Hemorrhage followed by hypertensive disorders of pregnancy were the most common disorders seen in near miss cases. All near miss cases required either HDU and/or ICU stay. The total requirement of blood and blood products by all near miss cases in the study was six whole blood, 61 packed red blood cells, 62 platelets and 42 fresh frozen plasma. The neonatal and perinatal mortality rate of our study was 38.8%.: A near-miss tool that is more generalizable, especially in a low-resource setting where many deliveries occur at home, needs to be developed. It should also be simple enough to be used by accredited social health workers, auxiliary nurse and midwife and other health care workers.