Severe Acute Maternal Morbidity and Intensive Care in Paropakar Maternity and Women’s Hospital

Upadhyaya, Indira; Chaudhary, Pankaj

doi:10.3126/njog.v8i2.9768

Cited by 12 publications

(16 citation statements)

References 13 publications

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“…In a study by Yelikar et al the MNM cases were more with hypertensive disorders like eclampsia and preeclampsia. 9 Similar observation of hypertensive disorders are the leading causes for the maternal illness were found in Upadhyay et al and Huseyin et al 13,14 Where as in present study the percentage of hypertensive disorder in pregnancy are least which shows that better antenatal care at our hospital.…”

Section: Discussionsupporting

confidence: 86%

A study of maternal near miss at a district teaching hospital: a retrospective observational study

Manjunatha

Harsha

Damayanthi

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Maternal health is an integral part of health care system. Maternal mortality is an indicator of maternal health and health care delivery system. Severe morbid conditions require comprehensive approach. Hence the concept of Maternal Near Miss (MNM) has emerged. The data of maternal near miss helps to reduce the maternal death and helps to achieve the goals related to reduce the maternal mortality rate of the country as well as the world and to improve the quality of life of the woman population by a quality care. Objectives of present study were to identify and analyze the strategies undertaken in the management of maternal near miss and outcome, measures to improve the quality of care and to assess the various indicators of MNM.Methods: With the permission from the hospital administrators and after taking the ethical clearance from the institutional ethical committee, a retrospective observational study was conducted for the period of one year between January 2016 to December 2016 at district teaching hospital of Kodagu Institute of Medical Sciences, Madikeri, by collecting data from hospital records. Admissions to the ICU as well as wards which fit in to the WHO maternal near miss criteria were included and studied.Results: WHO criteria for the MNM was followed. In present study, there were 25 MNM cases and four Maternal Deaths out of 3347 live births giving a maternal mortality ratio of 119/100000 live births (LB), Maternal Near Miss ratio of 7.46/1000LB, MNM:1MD ratio is 6.25 and mortality index (MI) is 13.79%. Twenty five cases of obstetric emergencies with serious concerns for maternal health were selected out of 97 cases who met the WHO criteria for MNM (25.77%). Twelve cases (48%) received multiple blood-transfusions, 8 cases (32%) of sepsis, 7 (28%) of PPH, and 5 (20%) of hypertensive disorder of pregnancy (pre-eclampsia, eclampsia). There were 12 cases (48%) that had more than one inclusion criteria. Surgical intervention was required in 8 (32%) i.e. 2 peripartum hysterectomies, 2 laparotomies, 1 manual removal of placenta, 1 uterine reposition and 2 traumatic PPH repair.Conclusions: Maternal-Near-Miss (MNM/SAMM) and its relation to maternal mortality contribute as sensitive measures of pregnancy outcome than mortality alone. Proper documentation is of paramount importance in analysis of data, to make conclusions and recommendation. Prospective structured study is required to get a clear picture and to suggest corrective measures which can be taken as far as obstetric care is concerned, to reduce maternal mortality and to achieve the sustainable developmental Goal (SDG) of maternal mortality ratio <70/100000 LB by 2030.

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Section: Discussionsupporting

confidence: 86%

A study of maternal near miss at a district teaching hospital: a retrospective observational study

Manjunatha

Harsha

Damayanthi

2018

Int J Reprod Contracept Obstet Gynecol

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“…Upadhyaya and Chaudhary, Moracs et al, and Huseyin et al, also reported the hypertensive disorder in pregnancy as leading cause of maternal illness. [13][14][15] Also, the Study by Souza JP et al, had incidence of severe preeclampsia in 36.3%, Eclampsia 9.7%, HELLP syndrome 5.6%. severe hemorrhage 10.5%, severe sepsis 6.4%.…”

Section: Discussionmentioning

confidence: 99%

A study on maternal near miss cases in Government Medical College Shivpuri, India

Jain

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and causes of maternal near miss due to severe obstetric complications and to identify the gapes and contextualize corrective measures to be taken in our facility.Methods: This is a retrospective study done in department of Obstetrics and Gynecology in GMC associated with DHS Shivpuri MP. The study was done during a period from 1st January 2018 to 30 April 2019.Results: In this study the hospital maternal near miss incidence ratio was 14.34%. In our study we found the most common morbidity was (30.18%) hypertensive disorder of pregnancy. These 159 near miss diagnoses were comprised of (30.18 %) cases of Hypertensive disorder of pregnancy, (27.67%) cases of major obstetric hemorrhage, (6.91) Severe systemic infection or sepsis, (4.40%) Labour related disorders. In Medical disorders very Severe Anemia, (1.88%) was most common cause of near miss. The most common cause of death was post-partum hemorrhage 37.5% and most of the patients referred from periphery in very critical condition. The median time taken to get clinical intervention among cases was 20-40 minutes after admission.Conclusions: Hemorrhage and hypertension disorders are the leading causes of MNM. Prompt diagnosis and adequate management of near miss cases can reduce mortality rates.

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“…This gives the incidence of 1.14% of all deliveries during the study period, which was low compared to a study done in one of the largest maternity hospital of Nepal which showed an ICU admission rate of 2.3% of all deliveries 12 . The major indications for ICU admission were hypertensive disorder and obstetric haemorrhage 13 .…”

Section: Resultsmentioning

confidence: 55%

Incidence and predictors of severe obstetric morbidity in a teaching hospital

Bajagain

Saha

2017

J. Kathmandu Med. Coll.

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Background: Evaluation of severe obstetric morbidity is an important aspect of optimum maternal health. Towards this, the Waterstone and Mantel criteria have been used to know the incidence, predictors and causes of severe obstetric morbidity. Objectives: The study aimed to estimate incidence, predictors and causes of obstetric morbidity at Kathmandu Medical College and Teaching Hospital. Methods: A hospital-based prospective study was carried out from 1 st September 2014 to 31 st August 2015. All cases of severe obstetric morbidity according to the Mantel and Waterstone criteria were identifi ed. The socio-demographic and healthcare characteristics of extremely severe cases were compared with controls which included women who were admitted before and after the indexed cases. Results: There were 2270 deliveries during the study period, out of which 74 cases of severe obstetric morbidities were identifi ed i.e. an incidence of 32.5 per 1000 deliveries. During the study period, there were three maternal deaths attributed to conditions studied. Disease-specifi c morbidities per 1000 deliveries were 18.9 for haemorrhage, 9.2 for severe pre-eclampsia, 0.88 for eclampsia, 0.44 for haemolysis elevated liver enzyme and low platelet count and 3.08 for sepsis. A total of 26 patients were admitted in Intensive care unit which was 1.145 per 100 of total deliveries. Conclusion: Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. In this study, most events are related to obstetric haemorrhage and severe pre-eclampsia.

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Severe Acute Maternal Morbidity and Intensive Care in Paropakar Maternity and Women’s Hospital

Cited by 12 publications

References 13 publications

A study of maternal near miss at a district teaching hospital: a retrospective observational study

A study of maternal near miss at a district teaching hospital: a retrospective observational study

A study on maternal near miss cases in Government Medical College Shivpuri, India

Incidence and predictors of severe obstetric morbidity in a teaching hospital

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