Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. Timely audit of the obstetrics near miss data would help in reducing maternal mortality.Methods: A retrospective chart review of the maternal near miss (MNM) and death based on WHO 2009 criteria was carried out in a tertiary care teaching hospital from Eastern India over 12 months. Main outcome measures were severe acute maternal morbidity (MNM) and maternal deaths.Results: During the study period, there were 9204 deliveries, 116 near miss cases, and 69 maternal deaths. The MNM incidence ratio was 13.75/1000 live births, MNM to mortality ratio was 1.68:1, and mortality index was 37.3%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hypertensive disorders accounted for the highest number of near miss cases (40.5%), followed by sepsis (31%), haemorrhage (18%), and dystocia (10%). The mortality index was 36.58%, 33.33%, 19.23%, and 07.6% for hypertensive disorders, sepsis, haemorrhage, and dystocia, respectively.  Most common causes of maternal deaths were hypertensive disorders, followed by systemic infections, HELLP syndrome, embolism, haemorrhage, malaria, and ruptured uterus. On bivariate analysis, there was an increased risk of maternal death in those illiterate, incomplete antenatal check-up (<3), multipara, preterm pregnancy, and home delivery.Conclusions: Hemorrhage and hypertensive disorders are the leading causes of MNM events and mortality. Early identification, remedial measures, and timely treatment would help to decrease the burden of maternal near miss and mortality.

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Maternal mortality is ascribed usually to complications that generally occur during or around labor and cannot be accurately predicted. The direct causes of maternal mortality, that is, hemorrhage, unsafe abortion, eclampsia, obstructed labor, infection, and others account for about three-fourths of maternal deaths. The remaining ABSTRACT Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths. Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019. Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause. Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.

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