RCOG World Congress 2023

A Retrospective, comparative analysis of the tends of near miss mortality and maternal mortality in a rural tertiary care centre.

Rumi Bhattacharjee1 , Vishal Sheth2, Ritesh Joshi3

Background for study:

ØSevere acute maternal morbidity is emerging as an important indicator for evaluating maternal health world wide.

ØThe MMR in India is 99/100000 Live births as on 2020.

ØAccording to WHO definition, 2009, maternal near miss is a woman who nearly died but survived a complication during pregnancy child birth or within 42 days after terminating pregnancy.

ØSince near miss women have traversed the same course of terminal events as maternal deaths and are themselves available for interrogation, it is a better method of reliable and statistically relevant quantitative analysis.

Aim & Objective

ØTo determine the prevalence and trend of - maternal near miss mortality cases, maternal near miss ratio, mortality index, maternal mortality rate and near miss to maternal death ratio.

ØTo compare near miss morbidities with maternal deaths with respect to demographics, disease profile, obstetric and perinatal outcome.

Design & Methods

ØStudy location : Shree Krishna Hospital

ØStudy Design :Retrospective observational analytic study.

ØData source : Medical records of both labor room registers and ICU files

Ø Observational descriptive statistics, Chi square / Fisher test were applied with help of SPSS 28.0.2.

ØStudy period : January 2014 to December 2021.

ØData source : Medical records of both labor room registers and ICU files

ØHospital ethical committee approval taken.

Results

ØNumber of patients with threatened conditions : 391

ØNear miss cases : 280

ØMaternal mortality cases : 111

ØMaternal mortality rate : 1215 per 100000 live births

ØMaternal mortality index : 28%

ØThe maternal death to near miss ratio : 2.5:1

Discussion

•Approximately 830 women die globally due to pregnancy related causes everyday especially in developing countries.

ØAs the samples size of near miss cases is more than maternal deaths, review of near miss cases has the potential to throw light on the quality of obstetric care provision in a more appropriate manner.

•The maternal near miss incidence ratio in our study was 30 per 1000 live births.

•73% of near miss and 93% mortality cases required ICU admissions.

•More than 40% patients in both groups received massive blood transfusion.

•Perinatal outcome as comparable in both groups.

•The large number of postpartum patients in the mortality group signify poor quality of obstetric care received at PHC, CHC level, unattended home deliveries or delayed referral.

ØMore than 92% of patients experiencing severe outcomes were unbooked emergencies.

ØMortality index is a reflection of the quality of obstetric care received by a women. Higher the index poorer is the quality of care. The Mortality Index in our study was 28%.

Limitations: Retrospective nature of the study, simple audit, single center.

Second half of study heavily influenced by covid-19 pandemic

Strength: High critical patient load.

Conclusion

It can safely be suggested that strengthening the tertiary care centers with staff, material and equipment across the country can reduce maternal mortality even in badly managed cases refereed from government or private setups.

References

1)Pradhan Mantri Matru Vandana Yojana. Available from URL: http://www.wcd.nic.in/sites/default/files/PMMVY%20Scheme%20Implemetation%20Guidelines%20._0.pdf. Accessed on 10-10-2018

2) Janani Suraksha Yojana (JSY). https://www.nhp.gov.in/janani-suraksha-yojana-jsy-_pg

3) Bansal M,Lagoo J, Pujari K,Study of near miss in obstetrics and maternal mortality in Bastar,

Chhattisgarh,

India, Int J Reprod contracept obst gynaecol. 2016;5:620-623. [Google scholar]

4) Roopa PS, Verma S, Rai L, Kumar P, Pai MV, Shetty “Near miss” obstetric events and

maternal deaths in a tertiary care hospital: an audit. J. https://doi.org/10.1155/2013/393758. J

Pregnancy. 2013;2013:393758. [PMC free article] [PubMed] [Google Scholar]

RCOG World Congress 2023

Comparative analysis of the trends of near miss mortality and maternal mortality

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