The need for life saving interventions in near miss cases

Background: A maternal near-miss case or severe acute maternal morbidity is “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Near miss cases are more common than maternal deaths. The major reasons and causes are the same for both maternal near miss and maternal death, so review of maternal near miss cases is likely to yield valuable information regarding severe morbidity, which could lead to death of the mother, if not intervened properly and in time. The met need for emergency obstetric interventions is one such indicator that has been estimated to show levels of health facility utilization in improving safe motherhood. Methods: A prospective study with subjects admitted with severe maternal morbidity and mortality to the Department of Obstetrics and Gynaecology, Government Rajaji Hospital, Madurai. The duration of study was 6 months from May 2022 to October 2022. Results: The total live births during the study period were 7821, maternal near miss was 64 and maternal deaths was 17. Women with life threatening conditions was 81 during the study period. Maternal near miss incidence ratio was 8.18 per 1000 and severe maternal outcome ratio was 10.3 per 1000 and maternal near miss: mortality ratio was 3.76. Maternal near miss cases with CNS, renal and endocrine disorders had poor antenatal care with more than 50% of the cases lacking antenatal care. More than 40% of the cases with hemorrhage and infection did not have antenatal care. Almost all causes of maternal near miss cases were higher among LSCS patients compared to vaginal delivery patients and the difference was statistically significant. Except heart disease, almost all causes of maternal near miss cases had higher proportion of admission by referral compared to self-admission and the difference was statistically significant. Hemorrhage was most common in post-natal period. Conclusions: The main aim of the study was to assess the incidence and type of near miss events, emergency, their presentation, diagnosis, critical care interventions that can be lifesaving, and the outcome of such interventions. The recommendations are proper preparation of standard of protocol and its implementation should be done. Further study to assess various levels of failure among near miss cases should be conducted. The assessment of health literacy among the subjects should be ascertained.