Using World Health Organisation near miss approach to assess preventable maternal morbidity and mortality at a tertiary care hospital.

Abstract

To determine frequency of severe maternal complications, maternal near-miss cases and maternal deaths in obstetric patients in a tertiary care setting. The prospective cross-sectional analytical study was conducted at the Obstetrics Unit of Combined Military Hospital, Kharian, Pakistan, from January to June 2019, and comprised cases of severe maternal complications, critical interventions and life-threatening situations. A conditions as defined by the World Health Organisation guidelines. Severe maternal outcome ratio, maternal near-miss, maternal mortality ratio, near-miss-to-mortality ratio and the mortality index were calculated. Data was analysed using SPSS 20. Of the 1054 live births during the study period, there were 42(3.9%) near-miss cases and 4(0.3%) maternal deaths. Management-based criteria identified 34(80%) cases, followed by clinical 14(33%) and laboratory criteria 2(4.7%). Maternal mortality ratio was 379/100,000 and near-miss-to-mortality ratio was 39/1000 live births. Severe maternal outcome ratio was 4.36 (42+4/1054). For near-miss cases, the mortality index was 8.6, and the maternal near-miss-to-maternal death ratio was 10.5:1. The use of a standardised near-miss criterion makes audit and comparison of results between hospitals and even countries having the same resources possible and reproducible.