Introduction: Maternal near-miss (MNM) reflects women who survive life-threatening obstetric complications and serves as a key indicator for the quality of maternal care. The present study aimed to analyze the clinical and sociodemographic characteristics, referral patterns, management practices, and maternal-fetal outcomes of severe acute maternal morbidity (SAMM) cases at a tertiary care center. Materials and methods: This prospective observational study was conducted from January 2024 to June 2025 at a tertiary care hospital. Pregnant women and those within 42 days of termination/delivery of pregnancy who fulfilled World Health Organization (WHO) MNM criteria were included. Data on sociodemographic characteristics, obstetric profile, referral pattern, clinical features, management, and maternal and fetal outcomes were recorded. Results: Among the 100 MNM cases, most women were aged 21-25 years (48 (48%)), resided in rural areas (65 (65%)), and were multigravida (69 (69%)). Anemia was highly prevalent, with moderate anemia in 45 (45%) and severe anemia in 36 (36%). Emergency lower segment cesarean section (LSCS) was the predominant mode of delivery (72 (73.4%)). Among the referred cases (n=77), district hospitals were the main source (49 (63.6%)), and 36 (46.7%) reached the tertiary center within 1 hour. Major obstetric complications included abruptio placentae (13 (13%)), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (10 (10%)), and disseminated intravascular coagulation (DIC) (9 (9%)), while shock was observed in 20 (20%) cases. The most frequent WHO near-miss laboratory criterion was oxygen saturation 60 minutes (90 (90%)), and 48 (48%) women required transfusion of ≥5 units of red cell concentrate. Fetal outcomes (n=98) showed live births in 77 (78.5%) cases, low birth weight in 40 (40.8%), and neonatal intensive care unit (NICU) admission in 33 (37.9%). Conclusion: MNM events in this study were commonly associated with severe obstetric complications, such as hemorrhage, hypertensive disorders, and anemia, and frequently required intensive medical interventions. Early recognition of high-risk pregnancies, timely referral, and strengthened critical care services may help reduce severe maternal morbidity and improve maternal and neonatal outcomes. However, the findings should be interpreted cautiously due to the descriptive design and single-center setting of the study.
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