Abstract
Objectives: The objective of the study was to determine maternal mortality ratio (MMR), maternal near miss incidence ratio (MNM IR), MNM to mortality ratio (MNM: MD), and mortality index (MI) and to know the prevalence, demographic distribution, causes and feto-maternal outcome of maternal near miss and maternal deaths. Methods: A retrospective review of near miss and maternal mortality over a period of 20 months in a tertiary teaching hospital in Punjab. Results: MMR was 998 MNM IR was 24.20/1000 live births. Maternal near miss mortality ratio was 2.4:1. MI was 29.21%. The most common cause of maternal mortality was hypertension, which was seen in 14 (53.84%) women. Among near miss cases, the most common complication noted was hemorrhage, seen in 40 (63.49%) cases. Among maternal deaths, 7 (26.92%) women delivered vaginally, 6 (23.07%) women underwent emergency cesarean section. Among near miss cases, 20 (31.74%) women delivered vaginally, 13 (20.63%) women underwent cesarean section while 7 (11.11%) had cesarean hysterectomy. Laparotomy for ruptured ectopic pregnancy was done in 6 (9.52%) women, 7 (11.11%) women had dilatation and evacuation, 3 (4.76%) had exploration of Uterovaginal canal. Preterm birth has seen in 8 (12.69%) in maternal deaths and 23(36.50%) in maternal near miss. Intrauterine fetal demise occurred in 4 (6.34%) in maternal deaths and 2 (4.87%) in near miss. Conclusion: The review of near miss cases is important to identify response of health care system to medical emergencies and provides opportunities to improve the quality of service.
Highlights
Maternal mortality is a critical indicator to evaluate the quality of maternal healthcare services
This has gained attention as the major reasons are same for maternal near miss and maternal death but near miss is more prevalent than maternal mortality, and investigating the instances of severe morbidity can identify health system response to maternal emergencies and to identify gaps and conceptualize corrective measures to be taken to improve the services [2]
Mortality index (MI): Number of maternal deaths divided by the number of women with life threatening conditions expressed as percentage
Summary
Maternal mortality is a critical indicator to evaluate the quality of maternal healthcare services. Maternal Near Miss is defined as a woman who survives life threatening conditions during pregnancy, abortion, childbirth or within 42 days of termination of pregnancy irrespective of receiving medical/ surgical interventions [2]. This has gained attention as the major reasons are same for maternal near miss and maternal death but near miss is more prevalent than maternal mortality, and investigating the instances of severe morbidity can identify health system response to maternal emergencies and to identify gaps and conceptualize corrective measures to be taken to improve the services [2].
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