Study of Maternal Near Miss Events at Nepal Medical College and Teaching Hospital

Abstract

Maternal near miss (MNM) is defined as woman who nearly died from complication during pregnancy, childbirth or within 42 days of termination of pregnancy but survives either due to care she receives or due to chance. Maternal near miss and maternal deaths share many characteristics and pathological processes and MNM being more frequent than death, review of MNM gives us an opportunity to assess the quality of obstetric care in the institutions and area of improvement. As maternal morbidity precedes maternal deaths, the study of near miss cases provides understanding of the determinants of maternal morbidity and mortality and help in reducing it. The aim of this study was to assess the MNM events in our institutions based on WHO organ dysfunction-based criteria. A descriptive cross-sectional study was carried out in a tertiary care hospital in Kathmandu over two years period from July 2020 to June 2022 after taking ethical clearance from Institutional Review Committee. During the study period, there were 3493 live births, 40 maternal near miss cases and no maternal deaths. The MNM ratio was 11.45/1000 live births and the prevalence of MNM was 1.13%. Postpartum hemorrhage 11 (27.5%), early pregnancy complications 8 (20%) and hypertensive disorder of pregnancy 5 (12.5%) were the major contributor of MNM. Coagulation/ Hematological system dysfunction 22 (55%) was the most common organ involved in MNM. ICU admission and blood transfusion more than five units were the common intervention done. Effective use of critical care, evidence-based intervention and timely referral will help to reduce maternal morbidity and mortality.

Evaluation of Maternal and Perinatal Outcome in Women With Borderline Afi and Oligohydramnios in Third Trimester: A Tertiary Care Hospital-Based Study

“…This difference in the incidence of NICU admission and special care was found to be statistically insignificant (p=0.1023). In the present study, the incidence of NICU admission in normal AFI group was comparable to study performed by Bachhav and Waikar [10], in borderline AFI group was comparable to study performed by Giri et al [5] and Gaikwad et al [6], and in oligohydramnios group was comparable to study performed by Gaikwad et al [6]. NICU admissions were not significantly increased with decrease in AFI in our study.…”

“…Our all three groups were comparable in terms of maternal age. Our results were comparable to results of studies conducted by Giri et al [5] and Gaikwad et al [6].…”

“…Waikar [10], Giri et al [5], Ghimire et al [11], Gaikwad et al [6], Indira and Devi [12], and Suvarna and Reddy [7].…”

Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study

“…Oligohydramnios puts the mother at risks of operative interventions and cesarean delivery [ 3 , 4 , 12 , 13 ]. It is associated with increased risk of delivering via cesarean section (CS) primarily due to non reasuring fetal heart rate pattern in labor [ 2 , 14 , 15 ].…”

“…These studies suggested the need for increased pregnancy surveillance when oligohydramnios is detected. Otherwise, the mere presence of oligohydramnios cannot justify pregnancy interventions including induction or cesarean delivery [ 5 , 13 , 18 ]. In general there is no adequate evidence to optimize the management of women with oligohydramnios and hence has always been open for controversy.…”