scholarly journals Near Miss Obstetric Events and Maternal Death: Experience in Combined Military Hospital, Dhaka

2019 ◽  
Vol 14 (1) ◽  
pp. 37-40
Author(s):  
Nasrin Ara Zaman ◽  
Khondaker Shahidul Ghani ◽  
Maj Umme Ruman
Keyword(s):  
Intensive Care ◽  
Maternal Mortality ◽  
Critically Ill ◽  
Emergency Services ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Safe Motherhood ◽  
Military Hospital ◽  
Fetal Mortality ◽  
Hypertensive Disorder

Introduction: Obstetric patients can become critically ill for pregnancy related complications other conditions unrelated to pregnancy and may require emergency intensive care. The survival of both the mother and baby depends on the emergency services that are provided at that critical moment. Objective: To evaluate the level of obstetric emergency services in Combined Military Hospital (CMH) Dhaka by comparative analysis of near-misses and mortalities. Materials and Methods: This descriptive cross-sectional study which was conducted by observation of critically ill obstetric patients admitted in general intensive care unit (ICU) of CMH Dhaka from July 2012 to June 2013. Data regarding the disease associated with pregnancy and complications requiring ICU admission or transfer were collected and analyzed to calculate the maternal mortality and near miss ratio. Results: During the study period, 44 cases have been shifted to ICU, representing 2.15% of 2050 deliveries. Haemorrhage (50%) and hypertensive disorder of pregnancy (36.36%) were the two main obstetrical complications requiring ICU management. Surgical intervention was required in 86.3% of cases, 68% required intensive monitoring in ICU followed by blood transfusion in 59% cases. The maternal mortality ratio was 195.12/100000 live birth and fetal mortality rate was 82.2 per 1000 deliveries. Conclusion: By adopting safe motherhood initiative, both morbidity and mortality of pregnant mother can be lowered down. Early diagnosis by assessment, prompt intervention by team of expert obstetricians, intensivist and anaesthetist in reserve ICU can reduce the maternal mortality and morbidity. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 37-40

scholarly journals Evaluation of Clinical Characteristics and Outcomes of Obstetric Patients Admitted to Intensive Care Unit

2018 ◽  
Vol 6 (1) ◽  
pp. 11-16
Author(s):  
Deepak Shrestha ◽  
Shreyashi Aryal ◽  
Sebina Baniya
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Gestational Age ◽  
Near Miss ◽  
Hypertensive Disorder ◽  
Obstetric Hemorrhage ◽  
Surgical Interventions ◽  
Emergency Cesarean

Introduction: The need for critical care support and admission to intensive care unit (ICU) in obstetric population is infrequent. The proportion ranges from 0.1 to 8.5%. Yet, obstetric admissions to ICU and mortality continue to have a significant impact on overall maternal health care. The study of epidemiology and predictors of obstetric admissions to ICU will prove a useful proxy for better understanding maternal near miss events and mortality. Methods: This was a case control study reviewing all the obstetric cases admitted to ICU over a study period of five years. The individual files were recovered from the record section and data pertaining to referral status, demographics, clinical profile and ICU information were retrieved. The ICU data comprised of the length of ICU stay, indications for admission, interventions required, and outcomes. The data were then compared to historical controls. Results: A total of 80 patients were admitted to ICU accounting for 0.84% of total deliveries and 4.6% of total ICU admissions. Mean age was 24.84 years, mean gestational age was 32.33 weeks, and mean blood loss was 707.27 ml. Hypertensive disorder of pregnancy followed by obstetric hemorrhage were the most common indications. Lower gestational age, increased blood loss, emergency cesarean sections, and surgical interventions were noteworthy risk factors for ICU admissions. There was a mortality rate of 5%. Conclusion: Hypertensive disorders account for the most number of admissions to ICU followed by obstetric hemorrhage. Lower gestational age, increased blood loss and emergency cesarean section are notable risk factors for ICU admission.

scholarly journals Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital

1970 ◽  
Vol 8 (2) ◽  
pp. 222-226 ◽  
Author(s):  
NS Shrestha ◽  
R Saha ◽  
C Karki
Keyword(s):  
Maternal Mortality ◽  
Teaching Hospital ◽  
Maternal Death ◽  
Scoring System ◽  
College Teaching ◽  
Near Miss ◽  
Hypertensive Disorder ◽  
Maternal Deaths ◽  
Medical College ◽  
Obstetric Morbidity

Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity; Maternal mortality; Five factor scoring system DOI: 10.3126/kumj.v8i2.3563 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 222-226

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 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.

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 Towards safe motherhood to - are we moving in the right direction?: experience from an urban health facility in South India

2019 ◽  
Vol 8 (7) ◽  
pp. 2851
Author(s):  
Ramya Thangavelu ◽  
Lalitha Natarajan
Keyword(s):  
Maternal Mortality ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Safe Motherhood ◽  
Quality Health Care ◽  
College Hospital ◽  
Mortality Ratio ◽  
Classical Triad ◽  
Maternal Suicide ◽  
The Right

Background: This study was designed to evaluate the institutional Maternal Mortality Ratio (iMMR) in our institution, a tertiary private medical college hospital and to suggest recommendations and possible interventions to reduce it.Methods: This retrospective descriptive study was conducted by reviewing the hospital records over a period of ten years from January 2009-December 2018. The case records were reviewed for maternal demographic characteristics and complications.Results: The total number of deaths during the study period was 21, giving an iMMR of 85.268 per 100000 live births. Most of the maternal deaths (>80%) occurred postpartum. Obstetric causes contributed to 57% of the deaths with hypertension and hemorrhage topping the list. Other causes were sepsis and non obstetric causes including one case of maternal suicide. 52.38% of the women died more than 48 hours after admission to the hospital, while 28.57% succumbed in less than six hours. Secondary complications noted were ICU admission, extended intubation, massive transfusion, operative intervention and multi organ dysfunction.Conclusions: The classical triad of Hypertension, Hemorrhage and Sepsis continues to be the major determinant of maternal mortality and are potentially preventable by promoting universal access to quality health care, strengthening of health services and ensuring accountability.

scholarly journals Skin Color and Maternal Near Miss: Exploring a Demographic and Health Survey in Brazil

2017 ◽  
Vol 39 (05) ◽  
pp. 209-216 ◽  
Author(s):  
Karayna Fernandes ◽  
Maria Sousa ◽  
José Cecatti
Keyword(s):  
Maternal Mortality ◽  
Health Survey ◽  
Skin Color ◽  
White Women ◽  
Maternal Mortality Ratio ◽  
Demographic And Health Survey ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Complications ◽  
Cross Sectional

Purpose In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006. Method A secondary analysis of the DHS database, a population-based cross-sectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated. Results In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women. Conclusion The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.

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 Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Samira Maerrawi Haddad ◽  
Jose Guilherme Cecatti ◽  
Joao Paulo Souza ◽  
Maria Helena Sousa ◽  
Mary Angela Parpinelli ◽  
...  
Keyword(s):  
Health Services ◽  
Maternal Mortality ◽  
Maternal Morbidity ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
World Health ◽  
Severe Maternal Morbidity ◽  
Factors Associated ◽  
Mortality Ratio

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors.Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed.Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P<0.001), delays related to quality of medical care (P=0.012), absence of blood derivatives (P=0.013), difficulties of communication between health services (P=0.004), and any delay during the whole process (P=0.039).Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

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.

Sign in / Sign up

Export Citation Format

Share Document