Maternal Health Care in Tertiary Hospital in Terms of Maternal Near Misses (MNM) Indicators (original) (raw)
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Study of maternal near miss and mortality in obstetrics in a tertiary care hospital
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2022
Background: Maternal health is an important aspect for the development of any country in terms of increasing equity and reducing poverty. In 2009, WHO came up with clinical, laboratory and management criteria for identification of the maternal near miss cases. Aim of the current study was to determine the level of near-miss maternal morbidity and mortality due to severe obstetrical complications or maternal disease in a tertiary care hospital. Objectives of the study were to compare the relation of near miss events with that of maternal mortality and to see the trend of near miss events.Methods: Cases were defined based on WHO criteria 2009. Study was conducted at GMERS Medical College and Hospital, Sola, Ahmedabad from 2020 to 2021. The study population were near miss cases and maternal deaths.Results: During the period of audit there were a total of 6776 deliveries, 6434 live birth, 145 near miss and 36 maternal deaths.Conclusions: Haemorrhage and hypertension are the leading caus...
Maternal Near Miss and Maternal Mortality as Health Indicators in a Tertiary Care Hospital
Journal of Evolution of medical and Dental Sciences, 2014
OBJECTIVES: To assess the various causes and incidence of maternal near miss (MNM) and maternal deaths (MD) and to define the limitations and to search the level of delay. METHODS: A prospective and observational study, including women who were admitted in emergency from April 2012 to March 2013 with severe maternal complications and who fulfilled any of the WHO criteria of MNM. Results: A total of 6008 live births (LB) and 156 severe maternal outcomes (25.9/1000 LB) were observed, consisting of 140 MNM (23.3/1000 LB) and 16 MD(266/100, 000 LB). The maternal near miss/mortality ratio was 8.75. Hypertensive disorders accounted for the most common event of MNM (50.6%), followed by haemorrhagic disorders (38.6%). Majority of maternal deaths were due to hypertensive disorders (31.2%) and sepsis (25%). CONCLUSION: Reduction of present MNM and MD may be achieved by strictly following management protocols for hypertension and haemorrhage.
Maternal Near Miss- an Indicator of Maternal Health in a Tertiary Care Hospital of Odisha
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Maternal near miss is higher in developing countries and causes are similar to those of maternal mortality namely haemorrhage, hypertensive disorders and sepsis. Objectives-1. To estimate the burden of maternal near miss in O and G Dept. of VIMSAR, Burla in terms of proportion and near miss indicators. 2. To assess the foetal outcome of patients with maternal near miss. MATERIALS AND METHODS It was a record-based cross-sectional study conducted in the Department of O and G, VIMSAR, Burla from July 2017-Dec 2017. Cases were defined based on WHO criteria. Relevant data was collected from case records of maternal near miss patients. RESULTS Out of 1406 deliveries, near miss cases were 89. Total live births during the study period were 1349 and there were 8 maternal deaths. Maternal mortality ratio was 593/ 100,000 live births. Maternal near miss incidence ratio was 65.95 and Mortality index was 8.2. Preeclampsia was the leading cause (40.4%) of morbidity of near miss cases followed by severe anaemia (29.2%) and eclampsia (19.1%). CONCLUSION Near miss approach helps to evaluate and improve the quality of care provided by health system by identifying the pattern of severe maternal morbidity and mortality, strengths and weaknesses in the referral system and the way in which improvement can be made.
A STUDY OF NEAR MISS OBSTETRIC EVENTS AND MATERNAL DEATHS IN A TERTIARY CARE HOSPITAL
Introduction: Maternal Near Miss refers to a women who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. Aims and Objective: To use the new WHO near miss criteria to investigate maternal morbidity and mortality. To determine the Maternal Near Miss Incidence ratio, maternal near miss to mortality ratio and to calculate the mortality index for each event. Methods: Women showing the presence of any one of the markers in WHO near miss criteria and all maternal deaths from October 2012 to March 2014 were included in the study. The study was conducted in department of Obstetrics and Gynaecology at Lady Hardinge Medical College and SSK Hospital, New Delhi, India. Observation: There were 19,077 deliveries, 18,631 live births, 161 near miss cases and 35 maternal deaths during the study period. Haemorrhage accounted for most common near miss event (39%) followed by infection (28.5%), anemia (19.2%) and eclampsia (13.3 %). The Mortality Index were 33.8%, 12.5%, 6% and 4.5 % for infection, hypertensive disorder, anemia and haemorrhage respectively. Near miss to maternal death ratio was 4.6:1 and maternal mortality ratio was 188 per 1,00,000 live birth. Conclusion: The quality of care received by critically ill obstetric patients in this centre is optimal for near miss events like haemorrhage and anemia as the mortality index were lowest for both events but needs to be improved for infections and hypertensive disorders of pregnancy.
Evaluation of maternal near miss cases in tertiary care centre
The New Indian Journal of OBGYN, 2019
Objective: A study to analyze maternal near miss obstetrics event and maternal mortality in a tertiary care centre. Methods: This was a retrospective analysis of data, from January 2015 to December 2017. For each eligible patient, medical records were reviewed. Their socio-demographic features, mode of delivery, diagnosis on admission, surgical intervention, ICU admission, duration of hospital stay and outcome were collected and analyzed. Results: There were 159 maternal near miss cases and 83 maternal deaths. Maternal near miss to mortality ratio was 1.92. During the study maternal near miss incidence (MNM ratio) was found to be 47. 73 per 1000 live birth. Mortality index in our study was 34.29. There was more than one delay in most of the patients. Delays were primarily in seeking health care and delayed referral. Haemorrhage, hypertensive disorders and rupture uterus are most common cause of maternal near miss in our study. Conclusion: Investigating the maternal near miss cases are important tool to get the information about the causes, identify the gaps and corrective measures to be taken in the health care system.
Study of Maternal Near Miss and Maternal Mortality in a Tertiary Care Hospital
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
As per the latest report of the Registrar General of India, Maternal Mortality Ratio of India has declined from 212 per 100,000 live births in the period 2007-09 to 130 per 100,000 live births [1]. Reducing Maternal mortality and improving existing health care is a prime concern both for the country and worldwide. Both, Maternal mortality and Maternal near miss are important indicators of maternal health. Maternal mortality, is often described as "the tip of the iceberg" [2], and maternal morbidity as the base. That is for each maternal death, there are several women who experienced a severe complication, nearly died but survived (near miss) [3]. Maternal Near Miss (MNM) is defined as "A Woman Who Survives Life Threatening Conditions during Pregnancy, Abortion, and Childbirth or within 42 Days of Pregnancy termination, irrespective of receiving Emergency Medical/Surgical Interventions" [4]. There are several advantages of using SAMM as a tool compared to maternal mortality, e.g.,-the woman is alive to give a detailed account of the series of the event, there are more number of cases of SAMM compared to maternal deaths. The health personnel are more forthcoming in giving detailed treatment information as there is no threat of punitive liability [5]. Hence, over the last decade; there is a gaining momentum to use MNM as an indicator of obstetric care, even in developing countries [5,6]. However, unlike maternal deaths, it often becomes difficult to define MNM cases. With passage of time and geographical boundaries, the definition of near miss has evolved and literature demonstrates different criteria being used to define near miss (disease specific, management specific, organ system dysfunction specific, WHO criteria [7] etc.,). Ministry of Health and Family Welfare (MOHFW), India, have recently laid down Operational guidelines [4] to define and report MNM cases, adapted for and use in the country. Being a relatively new guideline, there is paucity of well-designed, prospective studies using it to Audit Near Miss. Hence, this study was conducted, to identify gaps in the existing Health system in India and determine an approach to resolve them using the MNM review Operational guidelines, launched by MOHFW, India. This study, also aimed to determine the incidence of MNM to Maternal Mortality Ratio (MNRM) and the Mortality Index (MI) in a tertiary care
Maternal Near Miss in Minia maternity & children University hospital in 2018: A prospective study
Minia Journal of Medical Research, 2020
Introduction: The maternal mortality ratio in developing countries in 2013 was 230 per 100 000 live births versus 16 per 100 000 live births in developed countries. There are large disparities within countries, between women with high and low income and between women living in rural and urban areas. Aim of the Work: To study the three delays of maternal mortality cases in Minia Maternity & Children University Hospital a tertiary teaching hospital in 2018 and comparing it with the previous 3 years (2015 & 2016-2017). Patients and Methods: Project title: Maternal Near Miss in Minia maternity & children University hospital in 2018: A prospective study. Study funding: There are no costs for this study; Patients‟ data were collected with the intent to review cases of maternal mortality and severe morbidity (near miss). Data was collected by reviewing the patients' admission files of the Obstetric Department at Minia University hospital and tracing questionnaires of maternal mortality...
Frequency of Maternal Near-Miss in Obstetrical & Gynecology Unit of a Tertiary Care Hospital
Journal of Khyber College of Dentistry
Objectives: To determine the frequency of near-miss among patients admitted during pregnancy till postpartum period.Materials and Methods: This cross-sectional study was conducted in Gynecology & Obstetrics Unit (B) of Lady Reading Hospital, Peshawar from 9/12/2019 to 9/6/2020. All women between age 15-48 years during pregnancy till 42 days after the end of pregnancy, admitted in the ward were included while a pregnant lady with complication not associated with pregnancy were excluded. Data on complications, mode of delivery, age and parity were taken from registers maintained in labor room, obstetrical ward and intensive care unit. Effect modifiers like age, gestational age. parity, gravida and causes were controlled through stratifications by using chi square test while P-value < 0.05 was taken as significant.Results: Out of total of 611 women were observed in which mean age was 29 ± 10.91 years. About 238(39%) patients were observed for primi para while 373(61%) patients were ...
An Observational Study of Maternal Near Miss Cases in a Tertiary Care Centre
Journal of Evidence Based Medicine and Healthcare
BACKGROUND DM WIMS is the only tertiary care referral hospital in the hilly tribal district of Wayanad. This is an observational study of 20 maternal near miss cases that presented in our hospital over a period of 4 months. MATERIALS AND METHODS This study was conducted by collecting data over a period of 4 months. Total number of live births in this period was 373. There were 20 cases of maternal near miss cases. Maternal near miss cases were chosen based on the inclusion criteria provided by WHO near miss approach for maternal health. RESULTS There were 373 live births in the 4-month observational period. In these 4 months, there were 20 cases of maternal near miss cases in our hospital. That is, maternal near miss ratio was 53.6/1000 live births. The majority were referred cases with MNM ratio of intrahospital cases being 13.4/1000 live births. The potentially life-threatening complications were obstetric haemorrhage and hypertensive disorders, which coexisted in majority of the women. The obstetric haemorrhage was mainly due to abruptio placenta, which can be attributed to the hypertensive complications. Preexisting anaemia was present in 35% of the MNM cases increasing their morbidity. CONCLUSION The maternal near miss ratio was 53.6/1000 live births, which is high. This can be attributed to the fact that our hospital is the only tertiary referral hospital in the hilly tribal district of Wayanad. Despite the MNM ratio being high, there were no cases of maternal death in this period. Low maternal mortality indicates the good first line of management given at the periphery hospital.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Assessment of the occurrence of maternal near-miss (an event in which a woman comes close to maternal death, but survive), identify the factors of maternal near-miss and to find out the association between determining factors and selected sample characteristics of maternal near-miss women.Methods: A descriptive survey is carried out among purposively selected women admitted in the maternity unit of two tertiary hospitals of Kolkata. Data are collected by face-to-face interview using valid and reliable semi-structured interview schedule to identify factors of maternal near-miss. WHO selected maternal near-miss proforma (2011) is used for assessment of occurrence of maternal near-miss by using record analysis.Results: The occurrence of maternal near-miss is identified as 100 out of 1669 women admitted in maternity unit. Eclampsia occurred maximum (27%) followed by severe pre-eclampsia (19%), severe PPH (6%) among potentially life-threatening conditions. Multigravida (65%),...