Study of Maternal Near Miss and Maternal Mortality in a Tertiary Care Hospital (original) (raw)

Abstract

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

Figures (6)

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (55)

  1. on Maternal Mortality in India 2014-16. December 2013 [www.censusindia. gov.in/vital_statistics/SRS_Bulletins/MMR%20Bulletin-2014-16.pdf. Accessed
  2. 9 May 2019. Purandre CN. Maternal Near Miss Review: A way Forward. J Obstetri Gynecol
  3. India. 2013;63(4):213-15.
  4. Lale Say, João Paulo Souza, Robert C Pattinson. WHO working group on
  5. Maternal Mortality and Morbidity classifications. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287-96. Maternal Near Miss Review Operational Guidelines. In: Maternal Health Division,
  6. Purandare C, Bhardwaj A, Malhotra M, Bhushan H, Chhabra S, Shivkumar P.
  7. Maternal near-miss reviews: Lessons from a pilot programme in India. BJOG. 2014;121(Suppl. 4):105-11.
  8. Tura AK, Trang TL, van den Akker T, van Roosmalen J, Scherjon S, Zwart J,
  9. et al. Applicability of the WHO maternal near miss tool in sub-Saharan Africa: A systematic review. BMC Pregnancy Childbirth. 2019;19:79. https://doi. org/10.1186/s12884-019-2225-7.
  10. Chhabra P. Maternal near miss: An indicator for maternal health and maternal
  11. care. Indian J Community Med. 2014;39(3):132-37. International statistical classification of diseases and related health problems.
  12. Tenth revision (ICD-10). Volume 2. Geneva, World Health Organization:1993. World Health Organization. Evaluating the quality of care for severe pregnancy
  13. complication: The WHO near miss approach for maternal health. Geneva: World Health Organisation 2011. World health organization website available https:// apps.who.int/iris/bitstream/handle/10665/44692/9789241502221_eng.pdf;jses sionid=F564428C29BF130509455F3952064922?sequence=1.
  14. Roopa PS, Verma S, Rai L, Kumar P, Pai MV, Shetty J. 'Near Miss' obstetric
  15. events and maternal deaths in a tertiary care hospital: An audit. J Pregnancy. 2013;58:5. doi:10.1155/2013/393758.
  16. Almerie Y, Almerie MQ, Matar HE, Shahrour Y, Al Chamat AA, Abdulsalam A. Obstetric
  17. near-miss and maternal mortality in maternity university hospital, Damascus, Syria: A retrospective study. BMC Pregnancy and Childbirth. 2010;10:65. Bansal M, Lagoo J, Pujari K. Study of near miss cases in obstetrics and maternal
  18. mortality in Bastar, Chhattisgarh, India. Int J Reprod Contracept Obstet Gynecol. 2016;5:620-23.
  19. Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near-miss in a rural [13] hospital in Sudan. BMC Pregnancy and Childbirth. 2011;11(3):48.
  20. Rathod AD, Chavan RP, Thool P. Analysis of near-miss and maternal mortality at
  21. tertiary referral centre of rural India. The Journal of Obstetrics and Gynecology of India. 2016;66(S1):295-300. DOI 10.1007/s13224-016-0902-2.
  22. Tallapureddy S, Velagaleti R, Palutla H, Satti CV. "Near-Miss" Obstetric events
  23. and maternal mortality in a Tertiary Care Hospital. Indian J Public Health. 2017;61(4):305-08.
  24. Herklots T, van Acht L, Khamis RS, Meguid T, Franx A, Jacod B. Validity of
  25. WHO's near-miss approach in a high maternal mortality setting. PLoS ONE. 2019;14(5):e0217135. https://doi.org/10.1371/journal.pone.0217135.
  26. Gupta S, Wadhwa l, Gupta T, Kumari S, Gupta N, Pritam A. Evaluation of severe
  27. maternal outcomes to assess quality of maternal health care at a tertiary centre. Indian J Obstet Gynaecol. 2015;65(1):23-27.
  28. Latufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG. Applying the new
  29. concept of maternal near-miss in an intensive care unit. Clinics. 2012;67(3):225- 30. Rana A, Baral G, Dangal G. Maternal near miss: A multicenter surveillance in
  30. Kathmandu valley. J Nepal Med Assoc. 2013;52(190):299-304.
  31. Jayaratnam S, Burton A, Connan KF, De Costa C. Maternal 'near miss' at royal
  32. Darwin hospital: An analysis of severe maternal morbidity at an Australian regional tertiary maternity unit. Aust N Z J Obstet Gynaecol. 2016;56(4):381-86.
  33. Van Roosmalen J, Zwart J. Severe acute maternal morbidity in high-income
  34. countries. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):297-304.
  35. Ray N, Patil SK, Kshirsagar NS, Patil Yaminni, Laddad M. Maternal near miss
  36. in a tertiary care hospital: A cross sectional study. J Evolution Med Dent Sci. 2016;5(51):3252-54.
  37. Kalisa R, Rulisa S, Akker TV, Roosmalen JV. Maternal Near Miss and quality of care [23] in a rural Rwandan hospital. BMC Pregnancy and Childbirth. 2016;16:324-31.
  38. Parmar TN, Parmar AG, Mazumdar VS. Incidence of maternal "Near-Miss"
  39. Events in a tertiary care hospital of central Gujarat, India. J Obstet Gynaecol India. 2016; 66(S1):S315-20.
  40. Samant PY, Dhanawat J. Maternal near miss: An Indian tertiary care centre audit.
  41. Int J Reprod Contracept Obstet Gynecol. 2019;8:1874-79.
  42. Kamal S, Roy P, Singh S, Minz J. A study of maternal near miss cases at tertiary
  43. medical college of Jharkhand, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2375-80. doi:http://dx.doi.org/10.18203/2320-1770.ijrcog20172316.
  44. Thaddeus S, Maine D. Too far to walk: Maternal mortality in context. Soc Sci
  45. Med. 1994;38(8):1091-110. Available at https://nhp.gov.in/janani-suraksha-yojana-jsy-\_pg [last accessed on [28] 10 Feb 2020].
  46. National Family Health Survey-4. State Fact sheet, NCT Delhi. Ministry of Health
  47. & Family Welfare, Government of India. Available at:https://rchiips.org/NFHS/ index.shtml [last accessed on 10 Feb 2020].
  48. partiCularS OF CONtriButOrS:
  49. Ex-Senior Resident, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India.
  50. Associate Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India.
  51. Consultant and Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India.
  52. Associate Professor and Senior Specialist, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India.
  53. Consultant and Head, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India.
  54. Research Scientist, Department of Obstetrics and Gynaecology, VMMC and Safdarjang Hospital, New Delhi, India. plaGiariSM CheCKiNG MethOdS: [Jain H et al.] • Plagiarism X-checker: Aug 26, 2019 • Manual Googling: Aug 29, 2019 • iThenticate Software: Mar 24, 2020 (12%) etyMOlOGy: Author Origin NaMe, addreSS, e-Mail id OF the COrreSpONdiNG authOr: Dr. Garima Kapoor, A-1/7, Paschim Vihar, New Delhi, India.
  55. E-mail: garimak79@yahoo.co.in