Frequency and covariates of Maternal near-miss events and maternal deaths in a tertiary care hospital

Abstract

Objective

To determine the frequency and covariates of maternal near-miss events and maternal deaths in a tertiary care hospital.

Methodology

This cross-sectional study was conducted in the Gyne-A unit at Mardan Medical Complex, Mardan, from January to December 2018. We used a pre-designed proforma (WHO near-miss validated proforma) in which the patient's demographic variables, including her age, parity, gestational age at presentation, and booking status, were recorded. The frequency and nature of near-miss events and mortality were analysed, and 268 participants were identified according to the WHO near-miss inclusion criteria 2009.

Results

A total of 9130 deliveries were conducted at the Gyne-A unit, Mardan Medical Complex, from January to December 2018. In these deliveries, there were 8966 live births. There were 268 near-miss Obstetric events and 11 maternal deaths. The maternal near-miss incidence ratio of our unit was found to be 29.35 per 1000 live births. The maternal mortality index was 3.9%. The maternal near-miss-to-mortality ratio was 24:1.

The most common cause of near-miss in this study was found to be haemorrhage (43%), followed by severe hypertension (38%), uterine rupture (8%), and severe anaemia (7%). At the same time, the most common cause of maternal death was disseminated Intravascular coagulation due to haemorrhage (36%), followed by HELLP syndrome (18%) and uterine rupture (18%).

Conclusion

Our unit's maternal near-miss incidence ratio is 29.35 per 1000 live births. In addition, one woman died for every 24 near-miss events, reflecting the quality of obstetric care at our unit. Moreover, haemorrhage and hypertensive disorders were the main causes of maternal near-miss events and mortality. Hence, preventive strategies and early interventions can prevent maternal deaths.