Study of “three delay model” of maternal morbidity and mortality in two tertiary care hospitals of Belagavi

Abstract

INTRODUCTION: Every year millions of women around the world suffer from pregnancy, childbirth, and postpartum complication. Approximately 810 women die every day worldwide from preventable causes related to pregnancy and delivery. The concept of severe acute maternal morbidity or near miss was aptly developed for the present health-care system. The World Health Organization (WHO) has defined “near-miss” as a woman, who is close to death, survives a complication that occurred during pregnancy, delivery, or up to 42 days after the termination of her pregnancy. The important causes of maternal mortality and morbidity have been summarized as the three delays. These delays have been identified to understand the gap in access to adequate obstetric management. Delays in access to quality care have been identified as one of the important determinants of preventable maternal death. The present study was planned to assess the “three delay model” leading to the occurrence of severe maternal outcome (SMO) in two tertiary care hospitals of Belagavi, Karnataka, as proposed by the WHO near-miss approach. OBJECTIVE: This study aimed to study the “three delay model” leading to maternal morbidity and mortality in two tertiary care hospitals of Belagavi. MATERIALS AND METHODS: A cross-sectional study was conducted in two major tertiary care hospitals of Belagavi, namely KLE Dr Prabhakar Kore Charitable Hospital and Belagavi Institute of Medical Sciences Hospital for a duration of 1 year among antepartum, intrapartum, and postpartum mothers experiencing SMO. A sample of 200 was calculated based on the prevalence of previous maternal near-miss (MNM) incidence ratio. To assess the MNM cases, “Modified Facility Based MNM Review Form” was used. RESULTS: Out of 200 MNM cases, 145 (72.5%) subjects belonged to the age group of 21–30 years and 17 (8.5%) of the women were aged ≥31 years. The mean ± standard deviation age of the study participant was 25.0 ± 4.45 years. Based on the obstetric profile of the study subject, it was noted that 139 (69.5%) participants had presented to the study hospitals as unbooked cases and 93 (46.5%) were primigravida. Majority (160, 80.0%) of the MNM women had presented as referred cases. The MNM incidence ratio in the present study was recorded as 12.05/1000 live births with a MNM: maternal death ratio of 3.3:1. All types of delays were noted among the study participant in our study. Type I delay that consisted of lack of awareness and resources was seen in 134 (67.0%) MNM cases, followed by 130 (65.0%) experiencing Type II delay comprising logistics delay between home and health-care facility and in between the health facilities along with lack of communication network and the third type of delay being observed at the referring health facility in all the referred study participant. Assessment of association between maternal outcome and the “3 delay model” by use of logistic regression analysis suggested that women who faced any kind of delay (I, II, and III) during their pregnancy were more likely to end up with poor maternal outcomes. CONCLUSION AND RECOMMENDATION: The present study aimed to assess the delays that lead to poor maternal outcomes. The current study revealed the deficiencies that need to be tackled and taken care of on an urgent basis. Hence, there must be a multidisciplinary approach to manage the high-risk maternal cases for timely intervention and management and reduce the burden of maternal morbidity and mortality on a global scale.

Keywords

• maternal near miss
• severe maternal outcome
• three delay model
• world health organization