Maternal near miss are the cases that those womens who nearly died but survived as a complications during pregnancy and childbirth or within 42 days of termination of pregnancy. Maternal mortality has been the leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the WHO maternal near miss (MNM) has been adopted by the tertiary level hospitals as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health-care system to reduce maternal mortality.
Goal and objectives: The main objectives of the study are to identify the incidence of the maternal near-miss events, observe the trend of near-miss events, and compare the nature of near-miss events with maternal mortality.
Materials and Methods: It was an prospective study conducted in the department of obstetrics and gynecology at Chengalpattu medical college and hospital, Tamilnadu, India. From January 2023 – December 2023, over a period of one year. Potentially life-threatening maternal complications and maternal mortalities were identified and recorded in the case sheets of the patients and near miss registers were maintained in the department, and monthly near miss audit was conducted in the department. Near-miss cases were analysed based on the Health and Family Welfare Government of India guidelines 2014 and WHO criteria. Datas were collected on demographic characteristic including age, parity, nature of complications, intensive care unit admissions, and timing of near miss events in relation with admissions. Similarly statistical analysis was also done.
Results: The total no of near miss admission of the obstetrics and gynecology department during the study period was 62 and the maternal mortality was 11 cases. During the study periods the total no of deliveries were 10856 and total live births were 10,847. The incidence of Near miss was high in the age group of 26-30 years (22%) and the lowest incidence was seen in the extremes of age less than 20 years and more than 35 years each carries the risk of (9%). Among the etiology assessed Hypertensive disorders of pregnancy contributes majority of the near miss cases (33%) of this Hypertensive disorders of pregnancy Antepartum eclampsia contributes most of the cases, followed by Heart disease (20%) and post-partum hemorrhage (11%). With reference to the obstetric code near miss events is most commonly seen in primigravidas which contributes about (45%) of the cases, (98%) of the cases are being referred from secondary care referral centers and (2%) came as self. Comparing with educational qualifications (98%) of the near miss cases were educated. From this study the maternal near miss incidence of the institution is 5.7/100000 live births which indicates optimum quality of the treatment given at this institution and the focus has been aimed against 0 mortality. The maternal mortality ratio was 563:1which indicates for every 563 deliveries there is 1 maternal mortality.
Conclusions: Enlighting the causes of near miss events of pregnancy of our institution, Hypertensive disorders in pregnancy, heart disease complicating pregnancy and postop partum hemorrhage were the three leading major causes of maternal near-miss events and mortality followed by sepsis. As the near-miss analysis indicates the quality of health care and causes are almost similar to maternal mortality, so its registry should be followed along with maternal mortality.
International Journal of Clinical Obstetrics and Gynaecology
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