Maternal Near-Miss as a Surrogate Indicator of the Quality of Obstetric Care: A Study in a Tertiary Care Hospital in Eastern India.

Vinita Singh,Archana Barik

doi:10.7759/cureus.12548

Abstract

BackgroundMonitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health.Aim and objectiveThe objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India.Material and methodThis study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period.ResultsDuring the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission.ConclusionMNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.

Highlights

Reduction in maternal mortality is an essential component of the millennium development goal (MDG) [1]
The third delay is related to lack of proper care at the health care facility due to the delay in diagnosis of critical conditions or decision making or unavailability of resources or trained health care provider. On analyzing this aspect in our study, we found that 92% of maternal deaths and 62% of near-miss cases were having one or more organ dysfunction on admission, which suggests that the first and the second delays could be the primary reason for the high morbidity and mortality in our study
The current study was conducted to assess the incidence and causes of maternal near-miss and mortality in a tertiary care hospital situated in eastern India

Summary

Introduction

Reduction in maternal mortality is an essential component of the millennium development goal (MDG) [1]. Resource-limited countries like India and other Asian and African countries take the maximum burden where a woman's lifetime risk of dying during pregnancy and childbirth continues to be high as compared to developed countries. The broad base of this iceberg represents many more women who may have nearly died from life-threatening conditions but survived. These are the maternal near-miss cases, defined as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy [2]. Monitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health

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