NEAR MISS OBSTETRIC EVENTS AS A REFLECTION OF QUALITY OF MATERNAL HEALTH CARE
Near Miss Obstetric Events & Maternal Health
Objective: To determine frequency and nature of near-miss cases in obstetric patients in a tertiary care hospital.
Study Design: Cross-sectional descriptive study.
Place and Duration of Study: The study was conducted in obstetrics unit of Combined Military Hospital (CMH) Kharian from Jan 2013 to June 2013.
Material and Methods: The WHO near miss criteria 2009 was followed including clinical, laboratory and management based criteria for case identification. Main outcome measures were frequency of near miss and maternal mortality cases, near miss on arrival and during hospitalization, ICU admission and total hospital stay, calculating the mortality indices, maternal mortality ratio, mortality to near miss ratio, near miss cases/1000 deliveries were calculated.
Results: There were 76 near miss cases. Maternal mortality ratio was 676. Near miss cases were 70.3%. Maternal death to near miss ratio was 1:10. Mortality index for near miss cases was 8.4%. In near miss group most significant was cardiovascular 46% and hematologic system 32%. Interventions, renal, neurological and respiratory were 9.2%, 5.2%,3.9% and 2.6%respectively. In near miss cases 86% were referred and 14% booked.
Conclusion: This study showed that uniform criteria for identifying near miss cases can be used in a tertiary referral hospital setting especially for comparison of results and audit. Near misses provide relevant controls for maternal deaths since most women who die presumably pass through a phase of organ dysfunction before dying and evaluation of circumstances leading to this can help in formulating and revising health care protocols.