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

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