Near Miss Maternal Mortality in a Tertiary Care Centre: A Retrospective Study

Introduction:One of the most important metrics for evaluating the caliber of healthcare provided is maternal mortality. A near-miss register can provide insightful information on maternity care shortcomings, improving our healthcare systems capacity to recognize and resolve difficulties with staff, infrastructure, and detection. Both altered physiological and pathological circumstances that increase the risk of pregnancy set critical maternal patients apart from typical pregnant and puerperal women. Our studys goal was to assess the various near-miss incidents that mothers encountered in connection to maternal mortality. Methods: Retrospective data were collected from March 2020 to April 2023 at Smt. Kashibai NavaleMedicalCollegeandGeneralHospital,Pune, over aspan of three-years.Everypatientwhorequiredintensivecare unit(ICU) admission or became critically ill in Operation theatre (OT) or Causality during pregnancy,childbirthwithinforty-twodaysoftheendof thepregnancy,wereincludedinthisstudy.Duringthisstudyperiod,therewereatotalof 5,950deliveries,outofwhich5,938resultedinlivebirths(LB).Outofatotalof these 5950 pregnancies 58cases had adverse abnormal outcomes, among these 58 cases,50 wereclassifiedasmaternalnearmissand8asmaternalmortality. Results: The maternal mortality ratio (MMR) at our hospital was 134 per one lakh, which is marginallyelevatedduetodelaysinaccessingtimelymaternalhealthcareservices.Therewere 8/1000livebirths(LB),orthematernalnear-missratio(MNMR),whichisthenumberofmaternal near-misses per 1000 LB. Furthermore, 9/1000 LB was the severe maternal outcome rate (SMOR),whichmeasuresthenumberofseverematernaloutcomesforevery1000livebirths. Ourfindingsshowedthathemorrhageandhypertensivedisorderduringpregnancywerethe primary contributors to illness and death, with sepsis and severe anemia serving as the secondary causes. Among organ dysfunctions, cardiac illness was the leading cause of morbidityaswellasmortality,followedbyrespiratorydysfunction. Conclusion:Throughthisresearch,ithasbeenestablishedthatimprovingindividualhealthcare facilitiescanpreventcasesofnearmiss.Moreover,quickreferralafterfirst-linetherapywould be vital in saving the lives of pregnant women. Hence, timeliness when managing cases of maternalnearmissisimportant.Ourexperienceindicatesthatthereshouldbewell-equipped peripheralreferralunitswithtrainedmanpowertohandleobstetricemergenciesforinstance massive obstetrichemorrhages, sepsis and Eclampsia.