scholarly journals Evaluation of severe acute maternal morbidity and mortality at a tertiary referral center of Uttarakhand, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1601
Author(s):  
Lipi Verma ◽  
Ruchira Nautiyal ◽  
Pradeep Aggarwal
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Cross Sectional Study ◽  
Near Miss ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Tertiary Referral Center ◽  
Live Births ◽  
Life Threatening

Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication.

scholarly journals Injury amongst Medicolegal Cases in Department of Forensic Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (244) ◽  
pp. 1277-1282
Author(s):  
Arbin Shakya ◽  
Jenash Acharya ◽  
Sunil Joshi
Keyword(s):  
Confidence Interval ◽  
Road Traffic ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Physical Assault ◽  
Care Centre ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Life Threatening

Introduction: Victim of injuries presenting to a hospital is a medico-legal issue. So, with medical management, proper documentation of injuries should be done as a legal duty by all physicians attending such cases. The study aims to find the prevalence of injury amongst medicolegal cases inthe Department of Forensic Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was done amongst 328 medicolegal cases presenting at a tertiary center, from January 2019 to February 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: 2603202101). Convenience sampling was used to select study samples. After detailed history regarding the incidence, injuries were examined and documented in a performa. The data were entered in Statistical Package for Social Sciences version 18. Point estimate at 95% Confidence Interval was calculated along with frequency and percentagefor binary data. Results: Among 328 cases presenting to hospital for medicolegal issues, 237 (72.25%) (67.40-77.09 at 95% Confidence Interval) had injuries, out of which 170 (71.73%) cases were due to physical assault, 64 (27%) cases due to accident; 2 (1.26%) were undetermined. Majority of victims of injury were adult males, with mean age of 32.41±13.96 years. In most accidental injuries internal organs were also injuries and life-threatening. Conclusions: The prevalence of injuries amongst medicolegal cases was found to be higher in our study in comparison to other studies done in similar settings. Most of the injuries were due to physical assault; however, the majority of road traffic injuries were life-threatening. These road traffic injuries could have been prevented by following a safe system approach to road safety.

scholarly journals Maternal near miss events: a retrospective observational study in a tertiary care centre of central India

2018 ◽  
Vol 7 (6) ◽  
pp. 2142
Author(s):  
Ruchita Dadhich ◽  
Gita Guin ◽  
Sarika Rawat
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Significant Proportion ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Critically Ill Patient ◽  
Tertiary Care Centre ◽  
Severe Morbidity

Background: Clinically women who have survived complications during pregnancy and childbirth termed as Maternal Near Miss. The major reasons and causes are the same for both Maternal Near Miss and Maternal Death, so review of MNM cases is likely to yield valuable information regarding severe morbidity, which could lead to death of the mother, if not intervened properly and in time. Investigating the instances of severe morbidity may be less threatening to providers because the woman survived.Methods: It was a retrospective study conducted at the Department of Obstetrics & Gynaecology NSCB Medical College Jabalpur, Madhya Pradesh, India. Data of maternal death and maternal near miss was collected from the previous records from 1st January 2017 to December 2017 according to WHO 2009 criteria.Results: Total number of near miss cases was 164 and total number of Maternal Death was 111. Maternal Near Miss incidence ratio was 28.70 per 1000 live births. Maternal Near Miss to Maternal Mortality Ratio was 1.46 and Mortality index was 40.36%. Common cause of Near Miss events was hypertensive disorders of pregnancy - 85 cases (51.82%), followed by hemorrhage - 39 cases (23.78%). heart disease- 9 cases (5.48%) was also common during pregnancy.Conclusions: In summary, this study shows that besides 111 cases who died, there were another 164 cases who survived due to the prompt diagnosis and treatment received in our set- up However, the overall high incidence of near-miss to maternal mortality (1.46) indicates that a significant proportion of critically ill patient still die of these complications. Maternal near miss reviews will be the best tool for the betterment of community and health care systems.

scholarly journals A study to assess proportion of the maternal near miss to maternal death in a tertiary care teaching hospital of North East India

2020 ◽  
Vol 9 (6) ◽  
pp. 2486
Author(s):  
Pradip Sarkar ◽  
Jahar Lal Baidya ◽  
Ashis Kumar Rakshit
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Medical Disorders ◽  
Mortality Ratio

Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.

scholarly journals Factors associated with non-urgent visits to the emergency department in a tertiary care centre, western Saudi Arabia: cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035951
Author(s):  
Saja S Al-Otmy ◽  
Abeer Z Abduljabbar ◽  
Rajaa M Al-Raddadi ◽  
Fayssal Farahat
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Centre ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Factors Associated ◽  
Life Threatening

ObjectivesTo explore magnitude and factors associated with non-urgent visits to the emergency department (ED) in a tertiary care centre, western Saudi Arabia.DesignA cross-sectional study.SettingED of a tertiary care hospital in western Saudi Arabia.Participants400 patients, both men and women.InterventionsAn interview-based questionnaire was administered to a consecutive sample of patients who visited the ED during morning shifts, where primary healthcare centres (PHCs) and outpatient clinics were available.Primary outcome measureED visits classified as non-urgent versus urgent (excluding life-threatening conditions) based on the Canadian Triage and Acuity Scale (CTAS). Levels IV and V were classified as non-urgent.ResultsMajority of the cases were adult (97.3%) and half of them were women (54.8%). Non-urgent visits represented 78.5% among non-life-threatening cases. One-third of the patients (33.8%) had three visits or more to the ED during the past year. Main reasons for visiting the ED were perception that the condition was urgent (42.0%), easy access (25.5%) and limited resources and services at the PHCs (17.8%). Patients 40–50 years old were more likely to have non-urgent visits (OR=3.21, 95% CI 1.15 to 8.98). However, likelihood of non-urgent visits was significantly lower among patients with cancer (OR=0.37, 95% CI 0.19 to 0.72) and cardiovascular disease (OR=0.43, 95% CI 0.23 to 0.83), and those who live near the hospital (OR=0.49, 95% CI 0.28 to 0.88).ConclusionsThe current study reported overuse of the ED. Enhancement of the primary care services, in concordance with community awareness, is an important component to reduce burden due to non-urgent use of the ED.

scholarly journals Maternal near miss: an Indian tertiary care centre audit

2019 ◽  
Vol 8 (5) ◽  
pp. 1874
Author(s):  
Padmaja Y. Samant ◽  
Juhi Dhanawat
Keyword(s):  
Tertiary Care ◽  
Medical Science ◽  
Data Entry ◽  
Cross Sectional Study ◽  
Near Miss ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Adequate Treatment ◽  
Near Misses

Background: In practical terms, women are considered near-miss cases when they survive conditions which threaten their life i.e. organ dysfunction. Despite advances in medical science and increased awareness of measures for safe childbirth, unacceptably high maternal morbidity and mortality continues to plague developing countries like India. Our’s being a tertiary care centre, draws a lot number of high-risk patients and referrals. By auditing these near miss cases, we aim to identify the causes, factors leading to near miss, to identify management gaps to prevent near misses and maternal death.Methods: Retro-prospective cross-sectional study done over one and a half year. Patients were included based on the inclusion criteria. A questionnaire was used to evaluate the prospective cases and the indoor case sheets were used for retrospective cases. After data entry in excel sheet, data analysis was done using SPSS 21. Results were tabulated.Results: High number of Near Miss cases with preeclampsia being the commonest. Lack of proper facilities at the periphery health centers was the most common cause for referrals. Level 1 and level 2 delays were found in most cases.Conclusions: Timely referral, with adequate treatment at the peripheral hospitals will majorly reduce Near miss. Hence, proper development and functioning of peripheral hospitals are needed.

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 A prospective study on maternal near miss cases at a tertiary care hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 300
Author(s):  
Karuna Kanta Das ◽  
Sasindra Kumar Das ◽  
Dhritimala Das
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Obstetric Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Respiratory Dysfunction ◽  
Live Births ◽  
Tertiary Center

Background: Pregnant women’s health status is not only reflected by mortality indicators alone hence the concept of Severe Acute Maternal Morbidity (SAMM) is appropriate for present health providing system. It helps to evaluate the quality of obstetric care in a particular institute. The main objectives of the study were to find a) Incidence of MNMM; b) Disorders underlying MNMM; c) Socio-demographic variables among MNMM; d) Facilities and skills needed to handle these near miss situations.Methods: A prospective hospital-based study was conducted in the department of obstetrics and gynaecology, Gauhati Medical College and Hospital, Guwahati during the period 1st June 2018 to 31st May 2019. Cases were identified based on maternal near miss operational guidelines December 2014.Results: Out of 16222 live births, 241 near miss cases were identified during the study. The maternal near miss incidence ratio is 14.86 per 1000 live births. The maternal near miss to maternal mortality ratio is 2.025. Most common cause of MNMM is hemorrhage (48.54%) followed by hypertension (19.5%), anemia (13.28%), sepsis (10.37%), cardiac dysfunction (6.2%), liver dysfunction (0.83%), renal dysfunction (0.83%) and respiratory dysfunction (0.41%).Conclusions: The large magnitude of MNM cases may be attributed to improper management of obstetric emergencies at the referring hospitals, poor referral practices, inefficient transport system, limited availability of blood products and poor utilization of health care services at the peripheral hospitals. In our tertiary center, with the help of multidisciplinary action to all the near miss cases we can reduce maternal mortality to a great extent.

scholarly journals A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

2019 ◽  
Vol 8 (8) ◽  
pp. 3223
Author(s):  
Mishu Mangla ◽  
Ruchira Nautiyal ◽  
Deepmala .
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Community Support ◽  
Warning Signs ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Tertiary Care Centre ◽  
Mortality Ratio

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care. 

scholarly journals Burden and causes of maternal mortality and near-miss in a tertiary care centre of Kerala, India

2017 ◽  
Vol 6 (3) ◽  
pp. 807
Author(s):  
Sreekumari Umadevi ◽  
Simi Ayesha ◽  
Sreekumari Radha ◽  
Anish Thekkumkara Surendran Nair ◽  
Krishna Devadhas Sulochana
Keyword(s):  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Systemic Diseases ◽  
Maternal Deaths ◽  
Live Births ◽  
Time Period ◽  
Study Setting

Background: Reduction of maternal mortality remains a challenge for developing countries like India as per the sustainable development goals put forward by UN. Near-miss audit is emerging as a new tool for setting new protocols in reduction of MMR. This study aimed, to analyze the near miss events and mortality events which occurred in the study setting from January 2011 to December 2012, and to compare the causes that led to the events.Methods: A descriptive comparative study was conducted at SAT Hospital, Government Medical College, Thiruvananthapuram, a tertiary care center in Kerala, India on the data accounted for a period of 2 years, 2011 and 2012. Maternal near-miss during the period is studied according to WHO 2009 criteria and compared with the maternal deaths during the same time period. The data was recorded using structured proforma; the same proforma was used to record maternal mortality cases of the same period.Results: Total live births during the time period were 18,663. Eighty-eight near miss cases and 26 maternal deaths occurred during the study period. Incidence proportion of maternal near-miss was 4.71/1000 live births. Severe maternal outcome was 6 per1000. For every maternal death, there were 3.38 near-misses. Mortality index of our institute was 22.8% and maternal mortality ratio (MMR) of the study setting was 139/1 Lakh live births. Post-partum hemorrhage was the leading cause for near-miss and systemic diseases were the major contributors to mortality.Conclusions: It is evident from the present study that PPH, once the leading cause of maternal mortality is now the leading cause of maternal near miss and by improving the resources of FRUs it can be further reduced. Systemic diseases are emerging as a new threat to the obstetric population leading to mortality.

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