Incidence of maternal near miss and mortality cases in central India tertiary care centre and evaluation of various causes (original) (raw)
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A study on maternal near miss cases in tertiary care center, Chandrapur, Maharashtra, India
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and the causes of maternal near miss cases due to severe obstetrics complications.Methods: This is a retrospective study done in department of obstetrics and gynecology in GMC Chandrapur. The study was done during a period from 1st January 2019 to 31st December 2019.Results: In this study the hospital maternal near miss incidence ratio was 13.11%. In this study authors found the most common morbidity was (36.06%) hypertensive disorders of pregnancy, (28.68%) cases of major obstetric haemorrhage, (7.37%) severe systemic infection or sepsis, (2.45%) labour related disorders. In medical disorders very severe anaemia, (13.11%) was most common cause of near miss. The most common cause of death was pos...
A Study on Maternal Near Miss Cases in a Tertiary Care Centre in Western Rajasthan
Background-Obstetric near miss is an important indicator that reflects the quality of obstetric care in health facility. The aim and objective of the study was to find out the incidence the prevalence and the causes of maternal near miss due to severe of obstetric complication. Method-This is a retrospective study done in the department of obstetrics and gynaecology in Umaid Hospital Results-In this study the hospital maternal near miss incidence ratio was 14.34%. In our study we found the most common morbidity was (30.18%) hypertensive disorder of pregnancy. These 159 near miss diagnoses were comprised of (30.18 %) cases of Hypertensive disorder of pregnancy, (27.67%) cases of major obstetric hemorrhage, (6.91) Severe systemic infection or sepsis, (4.40%) Labour related disorders. In Medical disorders very Severe Anemia, (1.88%) was most common cause of near miss. The most common cause of death was post-partum hemorrhage 37.5% and most of the patients referred from periphery in very critical condition. The median time taken to get clinical intervention among cases was 20-40 minutes after admission. Conclusion-Hemorrhage and hypertensive disorders are the leading cause of maternal near miss. Prompt diagnosis and adequate management of near miss can reduce mortality rates.
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.
The Journal of Obstetrics and Gynecology of India, 2014
Objective Near miss audit improves understanding of determinants of maternal morbidity and mortality and identifies areas of substandard care. It helps health professionals to revise obstetric policies and practices. Methods A retrospective review of obstetric case records was performed to assess frequency ad nature of maternal near miss (MNM) cases as per WHO criteria. For each case, primary obstetric complication leading to maternal morbidity was evaluated. Obstetric complications were analyzed to calculate prevalence ratio, case fatality ratio, and mortality index. Results There were 6,357 deliveries, 5,273 live births, 247 maternal deaths, and 633 MNM cases. As per WHO criteria for Near miss, shock, bilirubin [6 mg%, and use of vasoactive drugs were the commonest clinical, laboratory, and management parameters. Hemorrhage and hypertensive disorders of pregnancy were leading cause of MNM (45.7 and 24.2 %) and maternal deaths (28.7 and 21.5 %). Highest prevalence rate, case fatality ratio, and mortality index were found in hemorrhage (0.53), respiratory diseases (0.46), and liver disorders (51.9 %), respectively. Conclusion Developing countries carry a high burden of maternal mortality and morbidity which may be attributed to improper management of obstetric emergencies at referring hospitals, poor referral practices, and poor access/ utilization of health care services.
Study of Maternal Near Miss Morbidity in a Tertiary Care Centre of Western Rajasthan
2021
Pregnant women’s health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. 2-3 SAMM has been studied extensively in the recent past as a complement for maternal mortality and also to evaluate the quality of obstetric care in that particular institution. This concept is superior over maternal death in drawing attention to surviving women’s reproductive health and lives and is equally applicable in developing countries as well as developed countries. In many developed countries, maternal mortality has fallen to single digits whereas near miss cases are more and hence useful in evaluation of the present system. Moreover, they have the advantage of not being as rare as maternal deaths for providing adequate information, as well as still being rare enough not to overload clinicians and data collection personnel within the facility. 4 Till recently there were no criteria set f...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
the target for India was to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 and 2015. As per the latest report of the Registrar General of India, sample registration system (RGI-SRS), Maternal Mortality Ratio (MMR) of India was 167 per 100,000 live births in the period 2011-13. 2 In terms of numbers, this translates into approximately 44,000 maternal deaths in India (303,000 maternal deaths during the same period globally). Despite a one third reduction since 1990, India remains one of the major contributors to maternal deaths in the world. As per the recent sustainable development ABSTRACT Background: Clinically women who have survived complications during pregnancy and childbirth termed as Maternal Near Miss. The major reasons and causes are the same for both Maternal Near Miss and Maternal Death, so review of MNM cases is likely to yield valuable information regarding severe morbidity, which could lead to death of the mother, if not intervened properly and in time. Investigating the instances of severe morbidity may be less threatening to providers because the woman survived. Methods: It was a retrospective study conducted at the
Comparison Between Maternal Death And Maternal Near Miss In A Teriary Center In Eastern India
Aims and objectives : This study was conducted with the aim to find out the maternal near miss indicators of our centre and to determine the causes and nature of the maternal near miss and deaths. Materials and methods: This was a prospective observational study conducted from 2019 to 2021 .All cases who met Ministry of Health and Family Welfare Government of India Guideline,2014criteria for maternal near miss were included in this study. Results :The most common direct cause of near miss in this study was hypertensive disorder of pregnancy which accounts for 84.91% (n=135) cases and 3.77% (n=6) of maternal deaths among them. Multisystem disorder was positively associated with maternal near miss (p-value=0.005) Conclusion: Hypertensive disorders in pregnancy and sepsis were the two leading direct causes of near-miss events followed by hemorrhage. Causes in near-miss and maternal mortality are similar. So, all women should have access to better quality of obstetric care to prevent, diagnose and manage the complications on time.
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...
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%),...
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