A descriptive study of maternal near miss cases in tertiary care center

Abstract

Introduction: Maternal near miss (MNM) case is defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal mortality is one of the important indicators used for the measurement of maternal health. Improvement of maternal health is one of the millennium development goals (MDG), MDG 5 with Target 5 A that calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. Materials and Methods: The study was conducted in the Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Medical College and Hospital Jamshedpur, Jharkhand which is a tertiary care centre and serves as a referral centre for other Primary Health Centre and District hospitals of Jharkhand. Cases of severe obstetric morbidity were identified during daily morning meetings, where all the new admission in the last 24 hour and serious inpatient cases were discussed. All the cases were followed during their hospital stay till their discharge or death. Results: During the 12 months of the study period, 10000 deliveries at the institution and 240 women were identified as near-miss obstetrical cases by five factor scoring system. The prevalence of near-miss case in this study was 2.4%. Near-miss per 1000 delivery was 24%. Maternal death to near miss ratio was 1:7.2. The leading causes of maternal near miss were hemorrhage (42.5%) and hypertensive disorder of pregnancy (23.5%) The morbidity was high in unbooked cases. Conclusion: Lesson can be learned from cases of near-miss which can serve as a useful tool in reducing maternal mortality ratio. Need for development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt.