Rozina Mustafa1, Haleema Hashmi. 1. Department of Obstetrics and Gynaecology, Baqai Medical University, Karachi. roz_mustafa@yahoo.com
Abstract
OBJECTIVE: To determine the frequency of near-miss cases, nature of near-miss events and mortality among obstetric patients. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: The study was conducted in the Obstetric Unit of Fatima Hospital, Baqai Medical University, from January 2006 to December 2006. METHODOLOGY: Near-miss case definition was based on validated specific criteria comprising of five diagnostic features: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anemia. The main outcome measures were frequency and characteristics of near-miss cases, total hospital stay, high dependency unit/ICU stay and development of multiple organ dysfunction. Near-miss events and maternal deaths were described with respect to disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for near-miss cases. The maternal death to near-miss ratio was calculated. RESULTS: There were 868 deliveries in the year 2006, 44 near-miss cases, 47 near-miss events and 6 maternal deaths. The maternal death to near-miss ratio was 1:7. The most common type of near-miss events were obstetrical haemorrhage, anemia and dystocia responsible for 51%, 21.2% and 14.8% respectively. Severe hypertensive disorders in pregnancy and infections accounted for 8.5% and 4.2% of near-miss events. Postpartum haemorrhage was responsible for 83.3% and infection for 16.6% of the maternal deaths. The mortality index was higher for infections (33.3%) than for haemorrhage (17.2%). Organ system dysfunction/failure was diagnosed in 18.1% of near-miss cases. CONCLUSION: This study showed that for every 7 women who survived life threatening complications, one died. However, the underlying disease processes for near-miss and mortalities were almost same. Evaluation of the circumstances surrounding near miss cases could act as proxy for maternal deaths in the studied population.
OBJECTIVE: To determine the frequency of near-miss cases, nature of near-miss events and mortality among obstetric patients. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: The study was conducted in the Obstetric Unit of Fatima Hospital, Baqai Medical University, from January 2006 to December 2006. METHODOLOGY: Near-miss case definition was based on validated specific criteria comprising of five diagnostic features: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anemia. The main outcome measures were frequency and characteristics of near-miss cases, total hospital stay, high dependency unit/ICU stay and development of multiple organ dysfunction. Near-miss events and maternal deaths were described with respect to disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for near-miss cases. The maternal death to near-miss ratio was calculated. RESULTS: There were 868 deliveries in the year 2006, 44 near-miss cases, 47 near-miss events and 6 maternal deaths. The maternal death to near-miss ratio was 1:7. The most common type of near-miss events were obstetrical haemorrhage, anemia and dystocia responsible for 51%, 21.2% and 14.8% respectively. Severe hypertensive disorders in pregnancy and infections accounted for 8.5% and 4.2% of near-miss events. Postpartum haemorrhage was responsible for 83.3% and infection for 16.6% of the maternal deaths. The mortality index was higher for infections (33.3%) than for haemorrhage (17.2%). Organ system dysfunction/failure was diagnosed in 18.1% of near-miss cases. CONCLUSION: This study showed that for every 7 women who survived life threatening complications, one died. However, the underlying disease processes for near-miss and mortalities were almost same. Evaluation of the circumstances surrounding near miss cases could act as proxy for maternal deaths in the studied population.
Authors: Asri Adisasmita; Carl V Smith; Ayman A E El-Mohandes; Poppy Elvira Deviany; Judith J Ryon; Michele Kiely; Quail Rogers-Bloch; Reginald F Gipson Journal: Matern Child Health J Date: 2015-07
Authors: Robert L Goldenberg; Sarah Saleem; Sumera Ali; Janet L Moore; Adrien Lokangako; Antoinette Tshefu; Musaku Mwenechanya; Elwyn Chomba; Ana Garces; Lester Figueroa; Shivaprasad Goudar; Bhalachandra Kodkany; Archana Patel; Fabian Esamai; Paul Nsyonge; Margo S Harrison; Melissa Bauserman; Carl L Bose; Nancy F Krebs; K Michael Hambidge; Richard J Derman; Patricia L Hibberd; Edward A Liechty; Dennis D Wallace; Jose M Belizan; Menachem Miodovnik; Marion Koso-Thomas; Waldemar A Carlo; Alan H Jobe; Elizabeth M McClure Journal: Int J Gynaecol Obstet Date: 2017-06-13 Impact factor: 3.561
Authors: Elizabeth M McClure; Robert O Nathan; Sarah Saleem; Fabian Esamai; Ana Garces; Elwyn Chomba; Antoinette Tshefu; David Swanson; Hillary Mabeya; Lester Figuero; Waseem Mirza; David Muyodi; Holly Franklin; Adrien Lokangaka; Dieudonne Bidashimwa; Omrana Pasha; Musaku Mwenechanya; Carl L Bose; Waldemar A Carlo; K Michael Hambidge; Edward A Liechty; Nancy Krebs; Dennis D Wallace; Jonathan Swanson; Marion Koso-Thomas; Rexford Widmer; Robert L Goldenberg Journal: BMC Pregnancy Childbirth Date: 2014-02-17 Impact factor: 3.007