Analysis of near-miss and maternal mortality at tertiary referral centre of rural India.

OBJECTIVE (1) To determine the incidence of near-miss, maternal death and mortality index; (2) to compare near-miss cases as per WHO criteria with that of maternal mortality; and (3) to study the causes of near-miss and maternal deaths. STUDY DESIGN Retrospective cohort study. SETTING Shri Vasantrao Naik Govt. Medical College, Yavatmal, India. STUDY POPULATION All cases of near-miss as per newer WHO criteria and maternal deaths. METHODOLOGY A cohort of emergency obstetric admission in the study setting during the study period was followed till 42 days after delivery, and cases fulfilled WHO set of severity markers for near-miss cases for severe acute maternal morbidity (SAMM) and mortality. All maternal deaths during the same period were analysed and compared with near-miss ones. RESULTS During the study period, there were 29,754 emergency obstetric admissions, 21,992 (73.91 %) total deliveries with 18,630 (84.71 %) vaginal deliveries and 3360 (15.28 %) caesarean deliveries. There were 161 near-miss cases and 66 maternal deaths occurred. The maternal near-miss incidence ratio was 7.56/1000 live births, while maternal mortality ratio was 2.99/1000 live births. Mortality index was 29.07, lower index indicative of better quality of health care. Maternal near-miss-to-mortality ratio was 3.43:1. Amongst near-miss cases, haemorrhage n = 43 (26.70 %), anaemia n = 40 (24.84 %), hepatitis n = 27 (16.77 %) and PIH n = 19 (11.80 %) were leading causes, while causes for maternal mortality were PIH n = 18 (27.27 %), haemorrhage n = 13 (19.79 %), sepsis n = 12 (18.18 %), anaemia n = 11 (16.16 %) and hepatitis n = 11 (16.66 %). CONCLUSION Despite improvements in health care, haemorrhage, PIH, sepsis and anaemia remain the leading obstetric causes of near-miss and maternal mortality. All of them are preventable. The identification of maternal near-miss cases using new WHO set of severity markers of SAMM was concurrently associated with maternal death. Definite protocols and standards of management of SAMM should be established, especially in rural Indian settings.