Study of near miss cases in obstetrics and maternal mortality in Bastar, Chhattisgarh, India

Abstract

INTRODUCTION According to millennium development goals (MDG) in 2015, the goal number five was to improve the maternal health is falling way below our target. Our aim in reducing maternal mortality by 75% has not been met with MDG. 1 Pregnant women's health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. 2,3 SAMM has been studied extensively in the recent past as a complement for maternal mortality and also to evaluate the quality of obstetric care in that particular institution. This concept is superior over maternal death in drawing attention to surviving women's reproductive health and lives and is equally applicable in developing countries as well as developed countries. In many developed countries, maternal mortality has fallen to single digits whereas near miss cases are more and hence useful in evaluation of the present system. Moreover, they have the advantage of not being as rare as maternal deaths for providing adequate information, as well as still being rare enough not to overload clinicians and data collection personnel within the facility. 4 Till recently there were no criteria set for identification of these cases for routine implementation, and wider application of this concept was limited. 5 But in ABSTRACT Background: According to millennium development goals (MDG) in 2015, the goal number five was to improve the maternal health is falling way below our target. Our aim in reducing maternal mortality by 75% has not been met with MDG. Pregnant women's health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. The main objectives of the study were to; (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index; (2) To compare the nature of near miss events with maternal mortality; (3) To observe the trend of near miss events. Methods: It was a retrospective study design conducted at Late B.R.K.M Government medical college, Jagdalpur, Chhattisgarh, India during September 2013 to August 2014. The study population includes near miss cases and maternal deaths. Cases were defined based on WHO criteria 2009. Results: Out of 3539 deliveries, 39 wear near miss cases during the study period. The maternal near miss incidence ratio was 11.9/1000 live births, maternal near miss to mortality ratio was 2.05:1, and mortality index was 32.7%. Hemorrhage was the leading cause (43.5%), followed by severe anemia (15.38%), rupture uterus (15.38%), preeclampsia/eclampsia (12.82%), sepsis (5.12%), complicated malaria (5.12%) and hepatitis (2.56%). Maternal mortality ratio (MMR) was 580/100000 live births. Conclusions: Hemorrhage was the leading cause of near miss events. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.