Ashma Rana1, Gehanath Baral2, Ganesh Dangal3. 1. Department of Obstetrics and Gynaecology, Tribhuwan University Teaching Hospital. 2. Department of Obstetrics and Gynaecology, Paropakar Maternity and Women's Hospital. 3. Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal.
Abstract
INTRODUCTION: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing Maternal Mortality Ratio is one of the challenges to achieve Millennium Development Goal. The objective was to determine the frequency and the nature of near-miss events and to analyze the near-miss morbidities among pregnant women. METHODS: A prospective surveillance was done for a year in 2012 at nine hospitals in Kathmandu valley. Cases eligible by definition were recorded as a census based on WHO near-miss guideline. Similar questionnaires and dummy tables were used to present the results by non-inferential statistics. RESULTS: Out of 157 cases identified with near-miss rate of 3.8 per 1000 live births, severe complications were postpartum hemorrhage 62 (40%) and preeclampsia-eclampsia 25 (17%). Blood transfusion 102 (65%), ICU admission 85 (54%) and surgery 53 (32%) were common critical interventions. Oxytocin was main uterotonic used both prophylactically and therapeutically at health facilities. Total of 30 (19%) cases arrived at health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All laparotomies were performed within three hours of arrival. Near-miss to maternal death ratio was 6:1 and MMR was 62. CONCLUSIONS: Study result yielded similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualified the recommended standard of care. The near-miss event could be used as a surrogate marker of maternal death and a window for system level intervention.
INTRODUCTION: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing Maternal Mortality Ratio is one of the challenges to achieve Millennium Development Goal. The objective was to determine the frequency and the nature of near-miss events and to analyze the near-miss morbidities among pregnant women. METHODS: A prospective surveillance was done for a year in 2012 at nine hospitals in Kathmandu valley. Cases eligible by definition were recorded as a census based on WHO near-miss guideline. Similar questionnaires and dummy tables were used to present the results by non-inferential statistics. RESULTS: Out of 157 cases identified with near-miss rate of 3.8 per 1000 live births, severe complications were postpartum hemorrhage 62 (40%) and preeclampsia-eclampsia 25 (17%). Blood transfusion 102 (65%), ICU admission 85 (54%) and surgery 53 (32%) were common critical interventions. Oxytocin was main uterotonic used both prophylactically and therapeutically at health facilities. Total of 30 (19%) cases arrived at health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All laparotomies were performed within three hours of arrival. Near-miss to maternal death ratio was 6:1 and MMR was 62. CONCLUSIONS: Study result yielded similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualified the recommended standard of care. The near-miss event could be used as a surrogate marker of maternal death and a window for system level intervention.
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: Stacie E Geller; Abigail R Koch; Caitlin E Garland; E Jane MacDonald; Francesca Storey; Beverley Lawton Journal: Reprod Health Date: 2018-06-22 Impact factor: 3.223
Authors: Mohd Noor Norhayati; Nik Hussain Nik Hazlina; Zaharah Sulaiman; Mohd Yacob Azman Journal: BMC Public Health Date: 2016-03-05 Impact factor: 3.295