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 EVALUATION OF OBSTETRIC NEAR MISS & MATERNAL DEATHS IN A TERTIARY CARE TEACHING HOSPITAL

2021 ◽  
pp. 1-2
Author(s):  
B. Harika ◽  
Bhavishya Gollapalli
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Maternal Health Services ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Mortality Ratio

Background: Maternal Mortality is a critical indicator to assess the quality of services provided by a health care system.The concept of severe acute maternal morbidity (SAMM) has been found to complement the assessment of maternal health services, since pregnant women’s health status is not reflected by mortality indicators alone . Maternal near miss cases are more common than maternal deaths. Methods: A Retrospective analysis of maternal near miss cases and maternal deaths was undertaken in the Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh over a period of two years. This study was conducted to find out maternal near miss and maternal deaths. Results: There were 2000 deliveries, 66 MNM cases and 2 maternal deaths during the study period. The Maternal Near Miss Incidence Ratio (MNMIR) ratio was 33%.The maternal near miss to mortality ratio was 33% for each maternal death. The Maternal Mortality Ratio (MMR) was 100 per 1 lakh live births in our study. Conclusion: We suggest near miss approach to evaluate and improve the quality of care provided by the health care system. By reviewing the near miss cases we can learn about the processes and their deficiencies that are in place for the care of pregnant women.

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 Maternal near miss review: a brief appraisal

2017 ◽  
Vol 6 (5) ◽  
pp. 1703 ◽  
Author(s):  
Sheeba Marwah ◽  
Manjula Sharma
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Health Care Services ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Services ◽  
Mortality Ratio

Recuperation of maternal health is mandatory for realms signatory to millennium declaration, as MDG 5A aims at reduction in maternal mortality ratio by three quarters between 1990 and 2015. MM is frequently described as “Just the Tip of The Iceberg” with a vast base of maternal morbidity that still remains largely undescribed. Hence, the concept of maternal near miss (MNM) or severe acute maternal Morbidity (SAMM) was instituted in maternal health care to complement information acquired from MDR. Here we present a succinct review to enlighten and update the readers about the concept of maternal near miss and its advantage in providing the modern-day obstetricians and the administrators an edge over maternal mortality in gauging the quality of health care delivered at each facility. This would thus be instrumental in helping them formulating policies to enhance the health care services at each level across the nation.

scholarly journals A study of maternal near miss at a district teaching hospital: a retrospective observational study

2018 ◽  
Vol 7 (4) ◽  
pp. 1421 ◽  
Author(s):  
Manjunatha S. ◽  
Harsha T. N. ◽  
Damayanthi H. R.
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Who Criteria ◽  
Live Births ◽  
Mortality Ratio

Background: Maternal health is an integral part of health care system. Maternal mortality is an indicator of maternal health and health care delivery system. Severe morbid conditions require comprehensive approach. Hence the concept of Maternal Near Miss (MNM) has emerged. The data of maternal near miss helps to reduce the maternal death and helps to achieve the goals related to reduce the maternal mortality rate of the country as well as the world and to improve the quality of life of the woman population by a quality care. Objectives of present study were to identify and analyze the strategies undertaken in the management of maternal near miss and outcome, measures to improve the quality of care and to assess the various indicators of MNM.Methods: With the permission from the hospital administrators and after taking the ethical clearance from the institutional ethical committee, a retrospective observational study was conducted for the period of one year between January 2016 to December 2016 at district teaching hospital of Kodagu Institute of Medical Sciences, Madikeri, by collecting data from hospital records. Admissions to the ICU as well as wards which fit in to the WHO maternal near miss criteria were included and studied.Results: WHO criteria for the MNM was followed. In present study, there were 25 MNM cases and four Maternal Deaths out of 3347 live births giving a maternal mortality ratio of 119/100000 live births (LB), Maternal Near Miss ratio of 7.46/1000LB, MNM:1MD ratio is 6.25 and mortality index (MI) is 13.79%. Twenty five cases of obstetric emergencies with serious concerns for maternal health were selected out of 97 cases who met the WHO criteria for MNM (25.77%). Twelve cases (48%) received multiple blood-transfusions, 8 cases (32%) of sepsis, 7 (28%) of PPH, and 5 (20%) of hypertensive disorder of pregnancy (pre-eclampsia, eclampsia). There were 12 cases (48%) that had more than one inclusion criteria. Surgical intervention was required in 8 (32%) i.e. 2 peripartum hysterectomies, 2 laparotomies, 1 manual removal of placenta, 1 uterine reposition and 2 traumatic PPH repair.Conclusions: Maternal-Near-Miss (MNM/SAMM) and its relation to maternal mortality contribute as sensitive measures of pregnancy outcome than mortality alone. Proper documentation is of paramount importance in analysis of data, to make conclusions and recommendation. Prospective structured study is required to get a clear picture and to suggest corrective measures which can be taken as far as obstetric care is concerned, to reduce maternal mortality and to achieve the sustainable developmental Goal (SDG) of maternal mortality ratio <70/100000 LB by 2030.

scholarly journals Maternal mortality-a three-year retrospective study in a rural medical college of India

2021 ◽  
Vol 10 (8) ◽  
pp. 3019
Author(s):  
Jayasree Hansda ◽  
Debobroto Roy ◽  
Krishnapada Das ◽  
Manojit Sarkar ◽  
Rumpa Das ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Demographic Profiles ◽  
Medical College ◽  
Mortality Ratio ◽  
Tragic Event

Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.

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 A retrospective analysis of maternal mortality in an urban tertiary care hospital

2021 ◽  
Vol 11 (1) ◽  
pp. 197
Author(s):  
Nishu Bhushan ◽  
Aakriti Manhas ◽  
Anju Dogra
Keyword(s):  
Maternal Mortality ◽  
Medical Records ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Mortality Ratio ◽  
Causes Of Deaths

Background: The aims of the study were to generate information regarding causes and complications leading to maternal deaths in an urban tertiary care centre and to find if any of the causes are preventable.Methods: The medical records of all maternal deaths occurring over a period of 4 years between January 2015 and December 2018 were reviewed.Results: Maternal mortality ratio ranged between 127 and 48 per 1, 00,000 births in the study. The causes of deaths were haemorrhage (29.47%), pregnancy-induced hypertension (PIH) (28.42%), anaemia (12.63%), sepsis (9.47%), thromboembolism (6.31%), hepatic causes (5.26%), blood reactions (3.15%), heart diseases (2.10%), central nervous system (CNS) related (1.05%) and others (2.10%). Maximum deaths occurred in women between 21-30 years of age. Mortality was highest in post-natal mothers (70.52%).Conclusions: Overall maternal mortality due to direct obstetric causes was (73.68%), indirect obstetric causes (22.10%) and unrelated causes (4.2%). 

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.

Prevalence and Risk Factors for Maternal Mortality at a Tertiary Care Centre in Eastern Nepal- Retrospective Cross Sectional Study

2021 ◽  
Author(s):  
Sarita Sitaula ◽  
Tulasa Basnet ◽  
Ajay Agrawal ◽  
Tara Manandhar ◽  
Dipti Das ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Type I ◽  
Maternal Deaths ◽  
Live Births ◽  
Contributory Factors ◽  
Mortality Ratio

Abstract Background:Maternal mortality ratio is an important public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and to identify the various risk factors and causes of maternal mortality.Methods: This is a retrospective study conducted in a tertiary care center of Eastern Nepal from 16th July,2015 to 15th July 2020. Maternal mortality ratio per 100,000 live-births over 5 years of study period was calculated. The causes of death, delays of maternal mortality and different sociodemographic profiles were analyzed by descriptive statistics.Results:There were total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in year 2015 to 2020. The mean age and gestational age of women having maternal deaths were 24.69 ±5.99 years and 36.15± 4.38 weeks of gestation respectively. The common causes of maternal deaths were obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis. The leading contributory factors to the death were delay in seeking health care and delay in reaching health care facility (type I delay:40.84%).Conclusions:Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors were due to delay in seeking care and delayed referral from other health facilities. Contributory factors related to maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and puerperium.

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