Maternal Near Miss-Experience At A Tertiary Care Teaching Hospital In Western India

Abstract

Background: Pregnancy-related morbidity and mortality continue to have a huge impact on the lives of Indian women and their newborns. Any pregnant woman can develop life-threatening complications with little or no advance warning. All women need access to quality maternal health services that can detect and manage such complications1. Complications during pregnancy and childbirth remain a leading cause of death among women of reproductive age in India2. Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these estimated 67000 maternal and 10,00000 newborn deaths occur every year3. The maternal near-miss event was defined as “any acute obstetric complication that immediately threatens a woman’s survival but does not result in her death either by chance or because of hospital care she receives during pregnancy, labor or within 6 weeks of termination of pregnancy4. Maternal mortality data in practical terms is the tip of an iceberg while the maternal near-miss data is invisible and which is a very important tool to reduce maternal mortality. Material And Methods: This is a retrospective observational study carried out among 80 maternal near-miss cases who were admitted in obstetric ICU fulfilling criteria for identification for maternal near-miss cases as per Maternal Near Miss Review Operational Guideline (December 2014) in the Department of Obstetrics and Gynecology, in our tertiary care teaching hospital, between October 1, 2018, to October 31,2020. Patient fulfilling criteria for identification of near-miss cases as per Maternal Near miss Review Operational Guideline (December, 2014) Minimum 3 criteria were included in the study. Result: During the study period total of 18360 obstetric patients were admitted, out of which 80 patients ended up becoming maternal near-miss cases. Among them majority of patients were in age group of 18-25 years and occurrence was high in multipara women. In many patients more than one underlying disorder was present. Hemorrhage (67.5%) followed by a hypertensive disorder of pregnancy (30.0%) was the commonest presenting disorder in near-miss cases. In spite of being highly preventable, maternal sepsis (6.2%) also contributes to being a major cause of morbidity. In our study, 15% of near-miss cases had associated medical conditions. 5 % of cases (n=4) in the present study faced acute severe respiratory depression (ARDS) after getting infected with covid-19 infection. There was need for massive blood transfusions in 63.75 %, magnesium sulfate therapy in 17.25%, use of cardiotonic /vasopressor drugs in 10.0%, obstetric hysterectomy in 23.75 % of cases. More than one management modality was followed in many patients. All the near-miss cases were covered with broad spectrum antibiotic therapy. Total 21 near-miss cases (26.25%) were identified to have delays. Delay in the decision to seek care (Delay 1) occurred in 2.5% of women. Educational backwardness, ignorance of pregnancy itself, lack of regular antenatal care, and failure to give importance to warning signals may be the contributing factors. Delay in accessing adequate care (Delay 2) was identified in 7.5% of women. Conclusion: Hemorrhage, hypertensive disorders of pregnancy, abnormalities of labor, anemia, and sepsis are still major contributing factors for maternal near-miss cases. Anticipation, early diagnosis, and prompt treatment of maternal complications can reduce maternal morbidity and mortality. Sensitization of the population for proper utilization of available maternal health care facilities is very vital for reducing maternal near-miss cases.All the maternal near-miss cases are living lessons, who despite their misery show us our deficiencies. [Mehta A Natl J Integr Res Med, 2022; 13(2): 36-42, Published on Dated:10/02/2022]