Abstract

Introduction: Severe Acute Maternal Morbidity (SAMM) is a tool which is more advantageous compared to maternal mortality as an indicator of obstetric care. The global MMR shows a reduction from 342 to 211 death per 1 lakh live birth from 2007 to 2017 with a 38% over 10 years. Under Millennium development goals (MDG)-5, goal was to reduce maternal mortality by 75% between 1990-2015. By the end of year 2020 MMR in India was 97 per lakh. Now the Sustainable development goal (SDG) is to reach MMR below 70 by 2030. Aims and Objectives: * To as certain the incidence of maternal near-miss indices * To as certain the reasons behind maternal mortality * To as certain the occurrences of near-miss instance Materials and Methods: A retrospective study was conducted at Cheluvamba hospital, Mysore, Karnataka, India during January 2022 to December 2022. Maternal fatalities and near miss incidents are included in the study population. Case definitions were made using the 2009 WHO criteria. Diagnoses of life-threatening illnesses were made, and cases that satisfied WHO 2009 criteria were chosen. Analyses of maternal mortality from the same time frame were also conducted. Anemia and other medical conditions were viewed as secondary causes leading to the mother's near-miss and death, while hemorrhage, hypertension, sepsis, and other conditions were classified as primary causes for patients based on their final diagnosis. Results: In our Institute, 8632 deliveries took place. In this study, the MMR was 251/100,000 live births, while the MNMIR (Maternal Near Miss Incidence Ratio) was 14/1000 live births. The ratio of MNM to MM was 5.7:1. The MI (total mortality) was 14.8%. The ratio of severe maternal outcomes to live births, or SMOR, was 16.8/1000. Hypertensive disorder (42.85%) was the leading cause of maternal mortality, with antepartum eclampsia being the main leading cause in our setup, followed by hemorrhage (19.04%). Among the near miss events, hypertensive disorder was the leading cause with 49.16%, followed by hemorrhage (31.66%), severe anemia, and abortion, which account for approximately 7.5%. Conclusion: Maternal morbidity and mortality can be decreased by recognizing the risk factors, identifying high-risk cases, promptly referring them, and stabilizing the referral system.

• 1.   Special bulletin on maternal mortality in India 2018-20. November 2022 revised. https:// censusindia.gov.in/
• 2.   World Health Organization. Maternal Mortality ratio (per 100 000 live births). Health Statistics and Health Information Systems. 2013;1.
• 3.   Nielsen HS, Eggebo TM. Millenium development Goal 5- an obstetric challenge. Acta Obstetricia et Gynecologica Scandinavica. 2012;91(9):1007-8.
• 4.   Purandre CN. Maternal Near Miss Review: A way Forward. J Obstetri Gynecol India. 2013;63(4):213 15.
• 5.   Maternal Near Miss Review Operational Guidelines. In: Maternal Health Division, Ministry of Health & Family Welfare. Government of India. 2014. http:// www. nrhmorissa.gov.in/writereaddata/Upload/ Documents/Maternal_Near_Miss_ Operational_ Guidelines.pdf.
• 6.   Stones W, Lim W, Al-Azzawi F, Kelly M. An investigation of maternal morbidity with identification of life-threatening “near miss” episodes. Health Trends. 1991;23(1):13-5.
• 7.   Sivalingam N, Looi KW. Clinical experience with management of near-miss cases in obstetrics. Medical Journal of Malaysia. 1999;54(4):496-503.
• 8.   L. Say, J. P. Souza, and R. C. Pattinson, “Maternal near misstowards a standard tool for monitoring quality of maternal health care,” Best Practice and Research, vol. 23, no. 3, pp. 287– 296, 2009.
• 9.   G. D. Mantel, E. Buchmann, H. Rees, and R. C. Pattinson, “Severe acute maternal morbidity: a pilot study of a definition for a near-miss,” British Journal of Obstetrics and Gynaecology, vol. 105, no. 9, pp. 985–990, 1998.
• 10.   M. Waterstone, C. Wolfe, and S. Bewley, “Incidence and predictors of severe obstetric morbidity: case control study,” British Medical Journal, vol. 322, no. 7294, pp. 1089–1093, 2001.
• 11.   F. A. Lotufo, M. A. Parpinelli, S. M. Haddad, F. G. Surita, and J. G. Cecatti, “Applying the new concept of maternal near-miss in an intensive care unit,” Clinics, vol. 67, no. 3, pp. 225–230, 2012.
• 12.   Roopa PS, Verma S, Rai L, Kumar P, Pai MV, Shetty J. ‘Near Miss’ obstetric events and maternal deaths in a tertiary care hospital: An audit. J Pregnancy. 2013;58:5. doi:10.1155/2013/393758.
• 13.   L. Say, J. P. Souza, and R. C. Pattinson, “Maternal near misstowards a standard tool for monitoring quality of maternal health care,” Best Practice and Research, vol. 23, no. 3, pp. 287– 296, 2009.
• 14.   J. van Roosmalen and J. Zwart, “Severe acute maternal morbidity in high-income countries,” Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. 23, no. 3, pp. 297–304, 2009.
• 15.   J. P. Souza, J. G. Cecatti, M. A. Parpinelli, S. J. Serruya, and E. Amaral, “Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: a cross sectional study,” BMC Pregnancy and Childbirth, vol. 7, no. 20, pp. 1–8, 2007.
• 16.   A. Prual, D. Huguet, O. Garbin, and G. Rabe, “Severe obstetric ´ morbidity of the third trimester, delivery and early puerperium in Niamey (Niger),” African Journal of Reproductive Health, vol. 2, no. 1, pp. 10–19, 1998.
• 17.   N. S. Shrestha, R. Saha, and C. Karki, “Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital,” Kathmandu University Medical Journal, vol. 8, no. 30, pp. 222–226, 2010.
• 18.   Y. Almerie, M. Q. Almerie, H. E. Matar, Y. Shahrour, A. A. Al Chamat, and A. Abdulsalam, “Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study,” BMC Pregnancy and Childbirth, vol. 10, no. 65, pp. 2–7, 2010.
• 19.   Upadhyaya I, Chaudhary P. Severe acute maternal morbidity and intensive care in Paropkar maternity and women’s hospital. NJOG. 2013;8(2):38-41.
• 20.   Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JA, Vasconcelos MX. Incidence and main causes of severe maternal morbidity in Sao Luis Maranhao, Brazil: A longitudinal Study. Sao Paulo Med J. 2011;129(3):146-52.
• 21.   Huseyin C, Cihan K, Ramzan A, Ziya YY, Murat E, Levent Y. Near miss obstetric cases: 4 years experience of a tertiary center. Gynecol Obstet Reprod Med. 2013;19(1):19-22.
• 22.   Souza JP, Cecatti JG, Parpinelli MA, Serruya SJ, Amaral E. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study. BMC Pregnancy and Childbirth. 2007;7:20.

Data Sharing Statement

Funding