Analytical Study of Near-miss Cases at Tertiary Care Center

Abstract

Background: “Childbirth is a rebirth for the mother”—an ancient saying summarizes the unpredictable life-threatening conditions that might occur during pregnancy. Maternal deaths form only the tip of the iceberg, while a large part of it is the maternal comorbid conditions that remain largely undescribed. Materials and methods: A retroprospective observational study was conducted in the Department of Obstetrics and Gynaecology in collaboration with ICU, including the COVID-ICU in a Tertiary Care Hospital. The audit involves all women who are very ill, pregnant or recently delivered women who nearly died but survived a complication during pregnancy, and childbirth or within 42 days of termination of pregnancy, fulfilling the WHO criteria admitted at the tertiary center at the study period of 18 months. Results: The audit revealed MNM incidence ratio of 34/1,000 live births and mortality ratio of 1,261/1,00,000 live births with maternal near-miss: maternal mortality ratio of 2.7:1 in 3,604 deliveries. The most common factor leading to near-miss is found to be hemorrhage followed by hypertensive disorders. Most of them were between 26 and 30 years, multigravida. Type-II delay is most commonly seen due to a lack of facilities at the peripheral centers. Conclusion: Setting up “High-risk pregnancy clinics” at the taluka level for early recognition and referral of high-risk patients, upgrading the infrastructure of peripheral centers, and need of increase in tertiary care hospitals in every district for provision of quality care. Encouraging blood donation from a family member of every patient registering their pregnancy.