Evaluating the Quality of Obstetric care at the Federal Government Polyclinic, Islamabad Using the Lens of WHO’s Maternal Near-Miss Approach

Abstract

Objective: To determine the frequency of maternal near-miss (MNM) incidents and maternal deaths among hospitalized pregnant women, while also documenting the underlying causes and associated conditions.

Methodology: This descriptive observational study was carried out at the Department of Obstetrics and Gynecology, Federal Government Polyclinic (FGPC), Islamabad, over a period of six months. A non-probability consecutive sampling approach was utilized. The study included all pregnant women who were admitted for obstetric care and experienced severe maternal outcomes (comprising of maternal near-miss and maternal mortality). Participants were monitored for six weeks following their discharge, childbirth, pregnancy termination, or until their decease. Individuals who did not provide consent were excluded.

Results: The obstetric facility witnessed 1213 deliveries during the research period, with the ages of participants ranging from 18 to 42 years with a mean age of 27.94±5.37 years. Among the 1213 live births, there were 31 cases of near-miss and an additional 3 cases of maternal mortality. Consequently, the frequency of near-miss incidents was calculated as 25.55 per 1000 live births. The near-miss to maternal mortality ratio stood at 10.33:1, with a mortality index of 0.088. The primary causes of severe maternal outcomes were obstetric hemorrhage (n=16) 47.05% and hypertensive disorders (n=7) 20.58%.

Conclusion: The study reveals that, for every ten women who survived critical obstetric complications, one unfortunately experienced mortality. Hemorrhagic events and hypertensive disorders constituted the commonest causes of near-miss cases and deaths. The utilization of the World Health Organization's Maternal Near-Miss (MNM) approach facilitates the identification of causes and circumstances linked to severe maternal outcomes. Consequently, this methodology enables the identification of areas for enhancement in obstetric care and the subsequent implementation of corrective measures.