Maternal near miss indicators at a tertiary care hospital and its implications

Objective: Maternal near-miss studies offer valuable insights into the effectiveness of maternal healthcare systems. This study examines near-miss indicators at a tertiary care hospital in India, aiming to identify areas for improvement and inform strategies for enhancing maternal health outcomes.

Methods: A prospective observational study was conducted at SCB Medical College, Odisha, India, from July 2015 to June 2016. Data on severe maternal outcomes were collected using WHO criteria. Near-miss indicators were calculated, which included severe maternal outcome ratio, maternal near-miss ratio, maternal near-miss mortality ratio, mortality index and hospital care indicators.

Results: The study identified 212 near-miss cases and 84 maternal deaths among 9336 live births. The maternal mortality ratio was 899 per 100,000 live births, a near-miss ratio of 22.7 per 1000 live births, mortality index of 28.3%. Hemorrhage, hypertensive disorders, and sepsis were common causes of near misses. Hospital access and intrahospital care indicators revealed deficiencies in accessibility and quality of care.

Discussion: High MNMR suggests inadequacies in health infrastructure and services in the vicinity of our centre as most cases were referred. But high mortality index highlights deficiencies in management at our centre further reinforced by poor hospital indicators and ICU admission rate. Hemorrhage leading to shock and use of vasoactive drugs imply a definitive delay in diagnosis and treatment. Most near-miss cases underwent caesarean section and had poor perinatal outcomes.

Conclusion: Strengthening peripheral healthcare, use of evidence-based medicine and expansion of ICUs can mitigate near-miss events and improve outcomes

Future Research: Longitudinal studies and the development of a maternal severity index are recommended for ongoing monitoring and quality assessment.