Maternal Near-Miss: A Multicenter Surveillance in Kathmandu Valley

Abstract

Introduction: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing maternal mortality ratio is one of the challenges to achieve Millennium Development Goal. Objective was to determine the frequency and the nature of near-miss (severe acute maternal morbidity) events and analysis of near-miss morbidities among pregnant women.Methods: Prospective surveillance was done for a year in 2012 in nine hospitals in Kathmandu valley. Cases eligible by definition recorded as a census based on WHO near-miss guideline. Similar questionnaire and dummy tables were used to present the result by non-inferential statistics. Results: Out of 157 cases identified with near-miss rate of 3.8, severe complications were PPH (40%) and preeclampsia-eclampsia (17%). Blood transfusion (65%), ICU admission (54%) and surgery (32%) were the common critical intervention. Oxytocin was the main uterotonic used both prophylactically (86%) and therapeutically (76%), and 19% arrived health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All of the laparotomies were performed within 3 hours of arrival. Near-miss to mortality ratio was 6:1 and MMR 62.Conclusions: Study result yields similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualify the recommended standard of care. The near-miss event can be used as a surrogate marker of maternal death and a window for system level intervention. Keywords: abortion, eclampsia, hemorrhage, near-miss, surveillance

Maternal near miss in low‐resource areas

“…WHO also developed a tool to classify near miss . Subsequently, numerous studies have used these criteria to define near miss worldwide …”

“…3,4 Subsequently, numerous studies have used these criteria to define near miss worldwide. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The WHO near-miss criteria were primarily designed for hospital settings under the assumption that these conditions usually result in maternal death when they occur outside the health facility. 4 However, numerous adaptations have been used across studies and in different settings.…”

“…4 However, numerous adaptations have been used across studies and in different settings. Depending on the geographic location, population, and specific details of the classification, studies of maternal near miss in low-and middle-income countries (LMICs) report frequencies ranging from less than 1% to more than 15% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). Almost all studies have been conducted in health facilities, ranging from tertiary referral hospitals to maternity care centers.…”

Near miss materno: fatores influenciadores e direcionamentos para redução da morbidade e mortalidade materna

“…Among the 17 studies included in this integrative review, seven were conducted in Brazil (9)(10)(11)(12)(13)(14)(15) , one in Argentina (16) , three in the African continent (17)(18)(19) and six in Asia (20)(21)(22)(23)(24)(25) .…”

A cross sectional study on severe acute maternal morbidity near-miss at tertiary care centre in Hyderabad, Telangana, India

“…4,5 The finding that postpartum haemorrhage contributes the largest proportion is in line with the findings of other severe maternal morbidity and maternal near miss studies (36.1 to 48.5%). [6][7][8] PPH was the leading initiating event in near misses indicating good quality care. This agrees with many Indian studies and that of Rwanda.…”