A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Abstract

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.

Incidence of Adverse Perinatal Outcomes among Women Exposed to Maternal Near-Misses in Arsi Zone in Ethiopia: Prospective Cohort Study in 2022

“…In this study, exposed women who were treated after half an hour (faced delay three) in the hospital were more than six times more likely to have adverse perinatal outcomes than nonexposed women (AOR = 6.40, 95% CI: 1.5–27.54). This finding is similar to studies done in Malaysia [ 30 ], Brazil [ 25 ], India [ 31 ], Mozambique [ 32 ], and Ethiopia [ 33 ] in that adverse perinatal outcomes were highly linked to third delay. This could be explained by the dearth of qualified and skilled personnel, inadequate staff, limited supply of medicine and equipment, poor facility situations, and poor attitudes and care on the part of healthcare workers which might be all possible explanations for the third delay, and interested parties working on the maternal and neonatal health should prioritize overcoming these impediments.…”