scholarly journals Evaluation of associated risk factors of near miss obstetrics cases at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

2018 ◽  
Vol 7 (2) ◽  
pp. 408
Author(s):  
Madan Khadka ◽  
Dhruba Kumar Uprety ◽  
Rubina Rai
Keyword(s):  
Risk Factors ◽  
Maternal Death ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Hypertensive Disorders ◽  
Life Threatening ◽  
Associated Risk Factors ◽  
Surgical Condition ◽  
Ruptured Uterus

Background: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near miss obstetric cases.Methods: A prospective observational study was done from August 1, 2014 to July 30, 2015 in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by 5 factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, complication of abortion, ruptured uterus, medical/surgical condition and sepsis.Results: A total of 9,727 delivery were attended during the study period from August 2014 to July 2014. There were 6307 (71.5%) vaginal delivery and 2777 (28.5%) caesarean section and 181 perinatal death with total of 9,546 livebirth. 162 near miss and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions of 172, Severe maternal outcome ratio of 18.64, Maternal near-miss: mortality ratio: 10.1:1, Mortality index: 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9% and cardiovascular and coagulation dysfunction as a major life-threatening condition and sepsis (25%) was the major cause of mortality.Conclusions: Haemorrhage and hypertensive disorders are the leading causes of near miss event. Evaluation of associated risk factor can be potential tool for reduction of maternal morbity and mortality.

scholarly journals Obstetric near miss events and maternal deaths in a tertiary care hospital

2018 ◽  
Vol 7 (2) ◽  
pp. 519
Author(s):  
Vrinda Patil ◽  
Vidya Kamath ◽  
Rathnamala M. Desai
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Mortality Index ◽  
Mortality Ratio ◽  
Life Threatening

Background: Maternal mortality is one of the important indicators of maternal health. Objectives of present study were to determine the frequency of maternal near miss, maternal near miss incidence ratio, maternal near miss to mortality ratio and mortality index and to study the risk factors associated with near miss events.Methods: A retrospective analysis of severe maternal morbidity from January 2015 to December 2015 was studied. Data was collected from women with pregnancy related life-threatening complications, near miss cases and maternal deaths.Results: The total number of deliveries were 5247. The numbers of maternal deaths were 12. Maternal mortality ratio was 228 per one lakh deliveries. There were 5.3 near miss events for every 1 maternal death. The nature and course of near miss cases were analysed. Severe maternal odds ratio was 14.48. Mortality index was 15.78%. Maternal near miss incidence ratio was 12.19.Conclusions: Near Miss Mortality indicator is helpful in identifying the life-threatening conditions and thus aiming to prevent maternal mortality. Hypertensive disorders and its complications are the leading causes of near miss events. Sepsis is the main cause of maternal death.

scholarly journals Maternal Near Miss in Patients with Systemic Lupus Erythematosus

2021 ◽  
Author(s):  
Arlley Cleverson Belo Silva ◽  
Sue Yazaki Sun ◽  
Felipe Favorette Campanharo ◽  
Letícia Tiemi Morooka ◽  
José Guilherme Cecatti ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Maternal Death ◽  
Lupus Erythematosus ◽  
Neonatal Death ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Control Group ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Life Threatening

Abstract Introduction: Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with coexisting SLE may have severe life-threatening risks. Severe maternal morbidities (SMM) include maternal death, maternal near miss (MNM), and potentially life-threatening conditions (PLTC). This study aimed to determine the prevalence of SMM in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods: This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at São Paulo Hospital , Brazil, from 2005 to 2015. The pregnant women were divided in control group without complications, group with PLTC, and group with MNM. Results: Out of 149 pregnancies, there were 14 cases of MNM (9.4%), 56 cases of PLTC (37.6%), and no maternal death. The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with control group [p=0.0042; OR (95% CI): 12.05 (1.5-96.6) for MNM group and p=0.0001; OR (95% CI): 4.84 (2.2-10.8) for PLTC group]. SMM increases the risk of longer hospitalization [p<0,0001; OR (95% CI): 18.8 (7.0-50.6) and p <0.0001; OR (95% CI): 158.17 (17.6-1424,2) for PLTC and MNM, respectively], newborns with low birth weight [p=0.0006; OR (95% CI): 3.67 (1.7-7.9) and p=0.0009; OR (95% CI): 17.68 (2-153.6) for PLTC and MNM group, respectively] as well as renal diseases [PLTC (58.9%, 33/56; p = 0.0069) and MNM (78.6%, 11/14; p = 0.0026)]. MNM cases presented increased risk for neonatal death [p=0.0128; OR (95% CI): 38.4 (3.3-440.3)], stillbirth and miscarriage [p=0.0011; OR (95% CI): 7.68 (2.2-26.3)]. Conclusion: SLE was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes, such as prematurity, neonatal death, miscarriage and fetal loss.

scholarly journals Maternal Near Miss Events in Tertiary Care Hospital: A Retrospective Observational Study

2021 ◽  
Author(s):  
Sonali J Ingole ◽  
Shilpa N Chaudhary
Keyword(s):  
Observational Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Hypertensive Disorders ◽  
Obstetric Haemorrhage ◽  
In Pregnancy

Introduction: Over the years, continuous efforts have been made for improving reproductive health status of women. In India, Ministry of Health and Family Welfare (MoHFW) has set Maternal Near Miss (MNM) review operational guidelines. Aim: Analysis of the incidence and causes of MNM cases in tertiary care hospital. Materials and Methods: This retrospective observational study was undertaken at a tertiary care hospital from January 2010 to September 2018. MNM cases were identified according to the criteria given by MoHFW, MNM review operational guidelines. Following parameters (variables) were noted viz., age, parity, obstetric haemorrhage, severe anaemia, sepsis, therapeutic interventions, etc., and analysed. Quantitative data was analysed by calculating means, ratios and proportions, using SPSS software (Version 21.0). Results: There were total 36,366 deliveries during the study period. A total of 315 Maternal Near Miss cases were noted. Hypertensive disorders n=133 (42.2%) in pregnancy was the leading cause of MNM events at the hospital. This was followed by obstetric haemorrhage n =97 (30.79 %), and severe anaemia constituting n=36 (11.42%), and Sepsis n=30 (9.52%). Mortality index was highest in the sepsis group n=5 (14.28%) followed by severe anaemia n=3 (7.69%). Conclusion: Hypertensive disorders were most common cause of near miss cases followed by obstetric haemorrhage. Sepsis was commonest cause of maternal mortality. Early identification of hypertensive disorders in pregnancy, obstetric haemorrhage, severe anaemia and sepsis; and prompt treatment of these causes may help in reducing near miss and maternal mortality.

scholarly journals Incidence of maternal near-miss events in a tertiary care hospital of Gujarat, India

2019 ◽  
Vol 9 (1) ◽  
pp. 145
Author(s):  
Vijay Kansara ◽  
Disha Vaja ◽  
Ajesh Desai
Keyword(s):  
Tertiary Care ◽  
Institutional Care ◽  
Rare Event ◽  
Obstetric Care ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Cross Sectional ◽  
Life Threatening

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near-miss cases five-factor scoring system was used. In 2009 WHO working group has standardized the criteria for selecting these cases. Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss.Methods: A facility-based cross-sectional study was conducted in the department of obstetrics and gynecology in GMERS medical college and hospital, Sola, Ahmedabad from January 1, 2019 to August 31, 2019. All maternal near-miss cases admitted to the hospital during the study period were recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant’s record.Results: During the period of study, 3235 deliveries were done at the institution while 16 cases of near-miss were identified. The prevalence of near-miss case in this study was 0.5%. Near-miss per 1000 delivery was 5%. Maternal death to near miss ratio was 1:2.67. The leading causes of maternal near miss were hypertensive disorders (62%) and haemorrhage (32%) The morbidity was high in un-booked cases.Conclusions: Maternal near miss is good alternative indicator of health care system. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization.

scholarly journals Profile of maternal near miss and determinant factors in a Teaching Hospital, Southwestern Nigeria

2018 ◽  
Vol 7 (9) ◽  
pp. 3450 ◽  
Author(s):  
Olusola P. Aduloju ◽  
Tolulope Aduloju ◽  
Oluwadare M. Ipinnimo
Keyword(s):  
Maternal Death ◽  
Uterine Rupture ◽  
Cross Sectional Study ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Southwestern Nigeria ◽  
Cross Sectional ◽  
High Dependency ◽  
Mortality Index ◽  
Life Threatening

Background: Maternal near miss (MNM) concept is becoming a tool for the assessment of severe maternal morbidity. The study examined the profile of MNM cases and their determinant factors.Methods: A cross-sectional study of pregnant women with near miss cases and maternal death using the WHO criteria between 1st January 2015 and 31st December 2016. Relevant data were collected with using a structured data form, analyzed using SPSS version 22 and logistic regression was done to determine factors associated with MNM.Results: The MNM incidence ratio was 17.4/1000 live births with overall mortality index of 17.5%. Hemorrhage (39.4%) was the commonest cause of MNM while uterine rupture (42.8%) was the most common cause of maternal death. Also, uterine rupture had the highest mortality index of 33.3%. Older age group, low education, rural dwellers and unbooked status of women were the significant determinants of MNM, p <0.05. The overall maternal death to near miss ratio was 1:4.7. The worst perinatal outcome occurred in women who suffered maternal death.Conclusions: The study showed suboptimal level of care for women with life threatening conditions. There is a need to develop evidence-based protocol for their management and provision of high dependency unit.

scholarly journals Maternal Near-Miss Obstetric Events and Maternal Mortality

2021 ◽  
Vol 15 (5) ◽  
pp. 980-983
Author(s):  
Shehla Channa ◽  
Hina Akmal Memon ◽  
Nayab Qasim ◽  
Abdul Rauf Memon ◽  
Ikram Ahmed Tunio ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Live Birth ◽  
Maternal Death ◽  
Maternal Health Services ◽  
Fetal Outcome ◽  
Cross Sectional Study ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Cross Sectional ◽  
Life Threatening

Aim: To know about the prevalence, characteristic and nature of near miss events and to relate the nature of near miss events with that of maternal mortality. Study design: Descriptive cross sectional study Place and duration of study: Department of Obstetrics & Gynecology Unit IV, LUMHS Jamshoro from 1st January 2020 to 31st December 2020 Methodology: Pregnancy outcomes segregated into maternal death, near-miss event, or live birth categories. Age, level of education, religion, and residence were socio demographic variables. Obstetrics characteristics and nature of maternal near-miss events also studied. Result: The prevalence of maternal near-miss event was 5.6%, and the maternal near-miss events were seen more in multigravida, pregnant women with the lack of antenatal care in referral cases. Live birth as fetal outcome was 75%. The maternal death to near-miss ratio in this study was 1:5. 44 (42.3%) postpartum haemorrhage and 28 (26.9%), hypertensive disorders cases were leading cause of maternal near-miss events. Conclusion: Every fifth women who survived life-threatening complications, one died. Maternal near-miss should be adopted as an indicator for evaluating maternal health services. Keywords: Maternal near-miss (MNM), Maternal mortality, Life-threatening complication

scholarly journals “Near Miss” Obstetric Events and Maternal Deaths in a Tertiary Care Hospital: An Audit

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Roopa PS ◽  
Shailja Verma ◽  
Lavanya Rai ◽  
Pratap Kumar ◽  
Murlidhar V. Pai ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Live Births ◽  
Hypertensive Disorders ◽  
Mortality Index ◽  
Mortality Ratio

Objectives. (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 that of maternal mortality. (3) To see the trend of near miss events.Design. Audit.Setting. Kasturba Hospital, Manipal University, Manipal, India.Population. Near miss cases & maternal deaths.Methods. Cases were defined based on WHO criteria 2009.Main Outcome Measures. Severe acute maternal morbidity and maternal deaths.Results. There were 7390 deliveries and 131 “near miss” cases during the study period. The Maternal near miss incidence ratio was 17.8/1000 live births, maternal near miss to mortality ratio was 5.6 : 1, and mortality index was 14.9%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hemorrhage was the leading cause (44.2%), followed by hypertensive disorders (23.6%) and sepsis (16.3%). Maternal mortality ratio (MMR) was 313/100000 live births.Conclusion. Hemorrhage and hypertensive disorders are the leading causes of near miss events. New-onset viral infections have emerged as the leading cause of maternal mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

scholarly journals A cross sectional study on severe acute maternal morbidity near-miss at tertiary care centre in Hyderabad, Telangana, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1761
Author(s):  
Mahesh Kumar Mummadi ◽  
Sowmya Javvaji
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Morbidity ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Severe Acute Maternal Morbidity ◽  
Life Threatening

Background: A maternal near-miss case is defined by World Health Organization (WHO) as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Severe acute maternal morbidity (SAMM) is the acronym for the more popular term of ‘near-miss’ cases. There are approximately 118 life threatening events of “near miss mortality” or SAMM for each maternal death. Analysing near miss cases can prevent maternal death.Methods: It is a retrospective study based on medical records. Sample size is all the pregnant cases admitted in Department of Obstetrics and Gynecology in AIMSR, Hyderabad, Telangana, India over the period of January 2015- June 2017 (two and half years) i.e. 2276. All records were gathered and each record that satisfy near miss criteria/maternal mortality were segregated, data has been collected on the occurrence of severe pregnancy-related complications or those who require critical interventions and admission to intensive care unit as per the proforma (according to WHO near miss questionnaire). Data entry done in MS Excel and analyzed using Epi Info.Results: Total MNM/SAMM patients were 85 out of 2276 pregnant women (3.7%). The duration of the stay, potential life-threatening conditions (PTLC), critical interventions, organ dysfunctions, mode of delivery, treatment for PPH, hypertensive disorders and associated conditions among SAMM patients were calculated. SAMM patients who has severe post-partum hemorrhage PPH were 24.7%, severe pre-eclampsia was 31.7%, eclampsia was 2.4%, patients with both severe PPH and eclampsia were 2.4%.Conclusions: Near misses can be prevented to some extent by spreading awareness about possible obstetric complications and risk stratification. The WHO tool for analysis of maternal near miss or SAMM can identify more preventable causes of maternal death. Prospective monitoring of maternal morbidity may be useful in identifying determinants of severe maternal mortality.

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