Study of Maternal Near Miss and Maternal Mortality in a Tertiary Care Hospital

Abstract

Introduction: There are several advantages of using Severe Acute Maternal Morbidity (SAMM) as a tool compared to maternal mortality as an indicator of obstetric care. The health personnel are more forthcoming in giving detailed treatment information as there is no threat of punitive liability. Hence, over the last decade, there is a gaining momentum to use Maternal Near Miss as an indicator of obstetric care. However, unlike maternal deaths, it often becomes difficult to define maternal near miss cases. Ministry of Health and Family Welfare, India, have recently laid down Operational guidelines to define and report MNM cases in the country. Being a relatively new guideline, there is paucity of well designed, prospective studies using Near miss definition as per it. Aim: To determine the incidence and cause of MNM cases and Maternal deaths in a tertiary care hospital and identify gaps in the existing Health system in India and determine an approach to resolve them. Materials and Methods: An Audit of Maternal Death and MNM cases was undertaken in a Safdarjang hospital in Delhi, India from October 2015 to December 2016. During this study period, all the women who met the criteria according to MNM Operational Guidelines were identified and enrolled in the study; specially the potentially life-threatening conditions were selected. The MNM indices were calculated. In data analysis, for qualitative data, proportions were calculated. Mean score was calculated for quantitative data. Test of significance of differences between proportions and mean were calculated. Qualitative data was analysed by Chi-square test and t-test was applied for quantitative data. Results: There were 31,925 deliveries at the Institute. The MNM IR (Maternal Near Miss Incidence Ratio) in this study was 8/1000 live births and the MMR was 421/100,000 live births. The MNM: MM ratio was 1.9:1. Overall Mortality Index (MI) was 34%. Severe Maternal Outcome Ratio (SMOR) was 12.2/1000 live births. Most common causes of MNM were haemorrhage (53.8%), hypertensive disorders of pregnancy (21.7%), medical disorders (13.3%) and obstetric sepsis (8.8%). Majority of Maternal deaths were due to direct obstetric causes (71.8%). The most common direct causes for maternal deaths were hypertensive disorders of pregnancy (31.2%). More number of women in the maternal death group (34.3% versus 27.7%) presented to the hospital with postpartum complications, however, the difference was not statistically significant. Illiteracy (p<0.01) and lower socio-economic status (p<0.0001) were associated with higher probability of maternal deaths. Conclusion: The most common cause of MNM was haemorrhage, mostly, post-partum haemorrhage. Mothers will benefit by up-gradation of the infrastructure of the peripheral health centres (like ensuring availability of blood banks, round the clock operation theatre facility, magnesium sulphate for seizure prophylaxis etc.,) along with a network of referral linkage to ensure speedy and appropriate referrals.

Keywords

• developing nation
• maternal health
• quality of care
• severe acute maternal morbidity