MATERNAL NEAR-MISS MORBIDITY AND MORTALITY –– A CONTINUUM
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Abstract
Objective: To determine the frequency and nature of maternal near-miss cases and to comparatively analyse near miss morbidities and maternal deaths in pregnant women.
Material and Methods: This descriptive study was conducted in Gynae A Unit, Khyber Teaching Hospital Peshawar from January 2012 to December 2013. Cases of maternal near miss morbidities were identified from records of women presenting with potentially life threatening complications in pregnancy. Maternal mortality during the same period was also analysed.
Results: A total of 71 women were identified as cases of maternal near-miss (MNM) with a frequency of 1.05%. Maternal
deaths were 20 with MMR (Maternal Mortality Ratio) of 283/100,000 live births and MNM to MMR ratio of 3.5:1.Causes were obstetrical haemorrhage in 23(32.39%), Hypertensive disorders of pregnancy in 21 (29.58%), Dystocia in 13(18.315), sepsis and Cardiac diseases in 7(9.86%) and 4(5.63%) cases of near miss while severe aneamia unrelated
to haemorrhage in 3(4.23%)cases of MNM. Of the 20 maternal deaths 8(40%) were due to haemorrhage, 4(20%) hypertension, 1(5%) dystocia, 4(20%) Sepsis, 2(10%) cardiac diseases in pregnancy. Mortality index (MI) for sepsis and cardiac disease were highest, 36.36% and 33.33% respectively. MI for haemorrhage was 25.81% and hypertension 16%. Forty two (59.15%) cases required intensive care unit admission with 22 (30.98%) requiring more than 3 units blood and component transfusion and 12 (16.90)% ventilator support. Surgical intervention in the form of emergency hysterectomy was done in 22 (30.98%) cases and 23 cases had different organ system failures.
Conclusions: Obstetrical haemorrhage, hypertensieve disorders, dystocia and sepsis are the leading causes of MNM. The underlying causes for severe morbidity and mortalities were almost the same, therefore evaluation of the circumstances
surrounding MNM could lead to improvement in the care and reduction in maternal mortality.
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