scholarly journals Indicators of maternal ‘near miss’ morbidity at different levels of health care in North India: A pilot study

2015 ◽  
Vol 14 (3) ◽  
pp. 254-257 ◽  
Author(s):  
Ravleen Kaur Bakshi ◽  
Pradeep Aggarwal ◽  
Debabrata Roy ◽  
Ruchira Nautiyal ◽  
Rakesh Kakkar
Keyword(s):  
Health Care ◽  
Health Centre ◽  
Medical Science ◽  
Maternal Outcome ◽  
Health Care Facilities ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Effective Measure ◽  
Live Births ◽  
Severe Maternal Outcome

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257

scholarly journals Factors Associated With Severe Maternal Outcomes at a Regional Referral Hospital in South-Western Uganda: A Case-Control Study

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Maternal Outcome ◽  
Referral Hospital ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Outcomes ◽  
Regional Referral Hospital ◽  
Live Births ◽  
Factors Associated ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

Background: The Sustainable Development Goal target is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Severe maternal outcome studies offer a panoramic assessment of obstetric care. Objective: The study aimed at determining the factors associated with severe maternal outcomes among women admitted at the obstetrics and gynecology ward of Mbarara Regional Referral Hospital. Methods: In an unmatched case control (1:2) study conducted between February and May 2018, 162 pregnant women admitted on the obstetrics and gynecology ward of Mbarara Regional Referral Hospital, or who had delivered within the past 42 days were recruited. Near miss cases were defined based on the WHO criteria. Near-miss cases and events, maternal deaths and their causes were retrospectively reviewed. Three categories of risk factors (socio-demographic, obstetric and health system) were examined. P-values <0.05 were considered statistically significant. A multivariable logistic regression model was used to identify factors associated with severe maternal outcomes. All analyses were performed using Stata software (Version 12.0, StataCorp, and College Station, TX). Results: In the four-month period there were 2301 live births, there were 45 near miss cases and 9 maternal deaths resulting in a severe maternal outcome ratio of 23.5/1000 live births, maternal near miss ratio of 19.6/1,000 live births, maternal near-miss mortality ratio of 5 and mortality index of 16.7%. Severe obstetric hemorrhage (33%), ruptured uterus (27.8%), sepsis or severe systemic infection (16.7%) and hypertensive disorders in pregnancy (16.7%) were the direct causes of severe maternal outcomes. About seventy-seven percent (77.8%) of the mothers with severe maternal outcomes were referred in from the peripheral health facilities, with a 4-time risk increased risk of a severe maternal outcome (aOR, 4.00; 95 % CI, 1.84-6.66, p-<0.001). Conclusion: Of the severe maternal outcomes, direct causes were the most prevalent and most of which are preventable. Being referred in was significantly associated with severe maternal outcomes. The maternal near miss indicators indicate need for improved quality.

scholarly journals MATERNAL NEAR MISS AND MATERNAL DEATHS IN KERALA, INDIA - A REVIEW

2020 ◽  
pp. 1-2
Author(s):  
Deepthy Balakrishnan
Keyword(s):  
Neurological Disorder ◽  
Maternal Morbidity ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Tertiary Centre ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

Aim- To determine the prevalence and pattern of near miss cases/ severe acute maternal morbidity cases and maternal deaths in a tertiary centre. Materials and methods - WHO 2011 criteria was used for identication of near miss cases. Results- In the study period of 2 years, there were 131 cases of severe maternal outcome (105 near miss and 26 maternal deaths). Maternal near miss incidence ratio is 5.62/ 1000 live births. Maternal near miss to mortality ratio is 4.03:1. The mortality index is 19.8%. Hemorrhage was the leading cause of near miss cases (44.76%) followed by hypertension(27.6%) but indirect causes(42.3%) led to maximum number of maternal deaths followed by hemorrhage. Among the indirect causes, cardiac and neurological disorder caused maximum mortality. Conclusion - Hemorrhage and hypertension were the leading causes of near miss but maternal mortality was more due to indirect causes. So it's important to involve specialist doctors from other departments to improve care of mothers and hence reduce maternal deaths further.

scholarly journals A study of maternal near miss cases in tertiary health centre in north India

2018 ◽  
Vol 7 (8) ◽  
pp. 3239
Author(s):  
Lovepreet Kaur ◽  
Manjit Kaur Mohi ◽  
Balwinder Kaur ◽  
Beant Singh
Keyword(s):  
Maternal Care ◽  
Health Centre ◽  
Near Miss ◽  
North India ◽  
Maternal Near Miss ◽  
Related Factors ◽  
Live Births ◽  
Medical College ◽  
Audit System ◽  
Mortality Ratio

Background: Maternal near miss is defined as woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.Methods: It was one-and-a-half-year prospective study from April 2016 to September 2017 conducted in the department of Obstetrics and Gynecology, Government Medical College, Patiala. The causes of maternal near miss based on WHO 2010 Near Miss criteria were studied.Results: In the present study out of total deliveries of 6166, there were 5461 live births and 123 maternal near miss cases which were included based on WHO 2010 maternal near miss approach. The maternal near miss incidence ratio (MNMR) in present study is 22.5. Literature reports the similar trends and MNMR varies between 15 to 40 per 1000 live births. Maternal near miss to mortality ratio is 1.89:1 in the present study.Conclusions: The most common direct cause for maternal near miss is hemorrhage. Severe preeclampsia is one of the easiest identifiable and avoidable factors for preventing maternal death. Studying near miss in detail allows us proper assessment of opportunities that were missed, analyzing the gaps and patient care related factors and helps to develop an audit system for maternal care.

scholarly journals Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
K. G. Fernandes ◽  
M. L. Costa ◽  
S. M. Haddad ◽  
M. A. Parpinelli ◽  
M. H. Sousa ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Skin Color ◽  
Maternal Morbidity ◽  
White Women ◽  
Maternal Outcome ◽  
Near Miss ◽  
Severe Maternal Morbidity ◽  
Maternal Near Miss ◽  
Maternal Outcomes ◽  
Severe Maternal Outcome

Background. Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods. This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results. Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion. Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

scholarly journals Analysis of Near Miss Cases as a Reflection of Emergency Obstetric Services and Need of Obstetric ICCU

2013 ◽  
Vol 5 (3) ◽  
pp. 99-101
Author(s):  
Ajesh Desai ◽  
Vijay Kansara ◽  
Disha Vijay Sahijwani
Keyword(s):  
Maternal Mortality ◽  
Organ Dysfunction ◽  
High Mortality ◽  
Maternal Outcome ◽  
Near Miss ◽  
World Health ◽  
Live Births ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Obstetric Services

ABSTRACT Objectives World Health Organization (WHO) has defined near miss case as ‘a woman presenting any life-threatening condition and surviving a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy’. This study aims to calculate near miss rate (NMR), maternal mortality rate (MMR), severe maternal outcome ratio, and near miss maternal death of our hospital. Indications of near miss events (NME) and their mortality index and the incidence of each organ dysfunction and its mortality index have been studied. Design A retrospective study of hospital records was done to complete proforma and summarize obstetric and perinatal events from April 2011 to October 2011 at Civil Hospital, Ahmedabad. Near miss events were identified according to criteria of organ dysfunction given by Mantel et al 1998. Results Out of total 3, 242 live births, 97 NME occurred among which 27 expired. Thus, NMR and MMR of our hospital is 21.5 per 1,000 and 832.8 per 100,000 live births respectively. Severe maternal outcome ratio is 29.9 (97/3242) and maternal mortality to near miss ratio is 1:2.58. Mortality index of our institute is 27.8% (27/97). 80.4% patients developed NME before hospitalization. Severe-PIH was the most common cause of NME but carried a low mortality index of 5.8%. Whereas, complicated cases of malaria and hepatitis E had high mortality index of 75 and 38.8% respectively. Conclusion This study describes a relatively high mortality index and NMR (21.5/1,000 live births) as compared to data from other developing countries. How to cite this article Sahijwani DV, Desai A, Kansara V. Analysis of Near Miss Cases as a Reflection of Emergency Obstetric Services and Need of Obstetric ICCU. J South Asian Feder Obst Gynae 2013;5(3):99-101.

scholarly journals Exploring Epidemiological Aspects, Distribution of WHO Maternal Near Miss Criteria, and Organ Dysfunction Defined by SOFA in Cases of Severe Maternal Outcome Admitted to Obstetric ICU: A Cross-Sectional Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Francisco Oliveira Neto ◽  
Mary Angela Parpinelli ◽  
Maria Laura Costa ◽  
Renato Teixeira Souza ◽  
Carolina Ribeiro do Valle ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Cross Sectional Study ◽  
Maternal Outcome ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Sectional Study ◽  
Cross Sectional ◽  
Who Criteria ◽  
Severe Maternal Outcome ◽  
Organic Dysfunction

Objective. To explore the epidemiological aspects, to describe the frequency and distribution of WHO maternal near miss (MNM) criteria and the presence of organ dysfunction and failure measured by the maximum SOFA (Sequential Organ Failure Assessment) score (SOFA max) in cases of severe maternal outcome (SMO). Methods. In an observational cross-sectional study performed between January 2013 and December 2015, 279 pregnant or postpartum women were admitted to an obstetric ICU (intensive care unit) in Brazil. MNM, maternal death (grouped as SMO), and potentially life-threatening conditions (PLTC) were defined according to WHO criteria. For categorical variables, a descriptive analysis was carried out. Frequency and distribution of WHO criteria, organ dysfunction, or failure defined by SOFA max were performed. Results. WHO criteria identified 65 SMO and 214 PLTC. Management criteria were present in 58/65 (89.2%) while 61/65 (93.8%) of SMO cases had dysfunction or failure by SOFA. Conclusions. The systematic evaluation of the organic function by SOFA max score identified the presence of organic dysfunction or failure in almost all SMO cases. Management criteria were present in all MD cases. Our results indicate the need for new studies evaluating the parameterization of the WHO laboratory criteria for values compatible with the definition of organic dysfunction by the SOFA to identify MNM.

scholarly journals Study of prevalence and factors associated with Maternal Near Miss (MNM) cases and maternal death at Rajiv Gandhi Government Women and Children Hospital, Pondicherry, India

2018 ◽  
Vol 7 (3) ◽  
pp. 1048
Author(s):  
Rakesh H. J. ◽  
Valsa Diana
Keyword(s):  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Health Centre ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Family Welfare ◽  
Good Opportunity ◽  
Live Births ◽  
Women And Children

Background: Maternal mortality is a critical event to assess the quality of a health care system. Analysing the maternal near miss provides a good opportunity for assessing the factors responsible for maternal mortality in that area. The objective of this study was to study the clinic-etiological profile of severe maternal morbidity/near miss case in a tertiary public maternity hospital using criteria from maternal near miss review operational guidelines Ministry of Health and Family Welfare, Government of India (2014).Methods: A prospective observational study included patients admitted to Rajiv Gandhi Government Women and Children Hospital, Pondicherry between August 2016 and July 2017. The patients who met Near Miss Criteria (a set of Clinical, Laboratory and Management based criteria) given by MoH and FW, Government of India (2014) were enrolled; their clinical and investigation parameters were recorded.Results: Out of 9583 live births, 27 (0.281%) were near-miss cases. The maternal near miss incidence ratio was low 2.81 /1000 live births, because of strict criterion of labelling near-miss cases. Maternal near miss to mortality ratio was 13.5:1, and mortality index was 6.89%, lower the index, indicates better quality of care. The mean age of the near-miss patients was 27.75 years. Most of the patients of near-miss were of multipara n = 17 (62.96%). Majority n = 16 (59.25%) of patients were at term gestation. The major causes of near miss were severe haemorrhage n = 11 (42%), Hypertension n = 9 (35%) and rupture uterus n = 4 (15%). Major intervention peripartum hysterectomy was needed in n = 7 (27%) and stepwise devascularisation only in another n = 5 (19 %) of near miss cases.Conclusions: Haemorrhage was the leading cause of near miss events. The study of maternal near miss provides an insight into the causes of maternal mortality in this region. The maternal morbidity and mortality can be reduced by providing proper antenatal care at primary and community health centre level and good intensive care and using maternal early warning system (MEWS) at tertiary level. Maternal near miss ratio is worth presenting in national indices.

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 Water, Sanitation, and Hygiene Service Availability at Rural Health Care Facilities in Southwestern Uganda

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Edgar Mugema Mulogo ◽  
Micheal Matte ◽  
Andrew Wesuta ◽  
Fred Bagenda ◽  
Richard Apecu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Centre ◽  
High Volume ◽  
Health Care Facilities ◽  
Hand Washing ◽  
Service Availability ◽  
Sanitation And Hygiene ◽  
Care Facilities ◽  
Improved Sanitation ◽  
Southwestern Uganda

There is a paucity of information on the state of water, sanitation, and hygiene (WASH) at health care facilities in Uganda. A survey on WASH service availability was conducted at 50 health care facilities across 4 districts of rural southwestern Uganda between September and November 2015. The main water points at the majority (94%) of the health care facilities were improved sources, while improved toilets were available at 96% of the health care facilities visited. Hospitals had the poorest toilet to patient ratio (1 : 63). Only 38% of the health care facilities had hand washing facilities at the toilets. The lack of hand washing facilities was most prominent at the level IV health centre toilets (71%). Hand washing facilities were available at other points within most (76%) of the health care facilities. However, both water and soap were present at only 24% of these health care facilities. The poor toilet to patient/caregiver ratios particularly in the high volume health care facilities calls for the provision of cheaper options for improved sanitation in these settings. Priority should also be given to the sustainable provision of hygiene amenities such as soap for hand washing particularly the high patient volume health care facilities, in this case the level IV health centres and hospitals.

scholarly journals A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

2016 ◽  
Vol 8 (4) ◽  
pp. 261-265
Author(s):  
Smiti Nanda ◽  
Shaveta Yadav
Keyword(s):  
Observational Study ◽  
Maternal Mortality ◽  
Prospective Observational Study ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Deaths ◽  
Live Births ◽  
Mortality Index ◽  
Severe Maternal Outcome ◽  
Mortality Ratio

ABSTRACT Purpose To study the incidence and causes of near-miss cases and maternal deaths (MDs) and also search the level of delay. Materials and methods The prospective observational study was carried out in the Department of Obstetrics and Gynecology for a period of one and a half year (September 2012 to February 2014). For identifying near-miss events, disease-specific criteria were used. Near-miss cases were identified among women with pregnancy-related complications whose diagnoses were meeting the criteria. Detailed information of maternal mortalities and near-miss cases for demographic features, underlying causes, treatment received, and level of delay were also obtained. Results There were 15,170 obstetric admission, 13,851 live births, 184 near-miss cases, and 60 MDs during the study period. The maternal near-miss (MNM) rate was 13.2/1,000 live births and maternal mortality ratio was 433.1/100,000 live births. The mortality index (MD/MNM+MD) was reported as 25%. The maternal mortality to near-miss ratio was 1:3.07. Severe maternal outcome rate (MNM/MNM+MD) was 17.6/1,000 live births. Hemorrhage (54.89%) was the leading cause of nearmiss events followed by hypertension (24.45%) and anemia (13.59%). Hypertension (26.66%) was responsible for most of the MDs followed by anemia (25%), hemorrhage (20%), and puerperal sepsis (10%). The most common level of delay was found on the part of women and/or family to seek help. Conclusion Hypertension, hemorrhage, and anemia are leading causes of maternal morbidity and mortality. Lessons need to be learnt from cases of near-miss, which can serve as a useful tool in making strategies and putting efforts to reduce maternal mortality. How to cite this article Yadav S, Nanda S. A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics. J South Asian Feder Obst Gynae 2016;8(4):261-265.

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