Ragini Kulkarni1, Sanjay Chauhan2, Rekha Daver3, Yogeshwar Nandanwar4, Anushree Patil5, Archana Bhosale4. 1. Department of Operational Research, National Institute for Research in Reproductive Health (ICMR), Mumbai, India. Electronic address: nirrhdor@yahoo.co.in. 2. Department of Operational Research, National Institute for Research in Reproductive Health (ICMR), Mumbai, India. 3. Department of Obstetrics and Gynecology, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India. 4. Department of Obstetrics and Gynecology, Lokmanya Tilak Municipal General Hospital and Medical College Sion, Mumbai, India. 5. Department of Infertility and Endocrinology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India.
Abstract
OBJECTIVE: To review the incidence and patterns of near-miss obstetric events (defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy"), as well as studying the classification criteria for near-miss events. METHODS: A prospective observational study was conducted in two tertiary hospitals in Mumbai. Women with near-miss obstetric events were interviewed during the period September 2012-August 2013. RESULTS: There were 884 near-miss events among 877 women, with seven patients readmitted. Clinical-criteria for near-miss events, accounting for 701 (79.3%) cases, were the commonest among the three classifications of near-miss events. Among the cases observed, hypertensive disorders of pregnancy (472 [53.4%]), severe anemia (185 [20.9%]), and postpartum hemorrhage 68 [7.7%]) were the most common causes of near-miss events. The most common problem encountered by patients prior to hospital admission for the near-miss cases was the unavailability of treatment at lower-level health facilities, affecting 598 (68.2%) of the 877 study participants. CONCLUSION: Hypertensive disorders of pregnancy, postpartum hemorrhage, and severe anemia remain important determinants in maternal morbidity. Facilities and training at first-referral units should be improved so that they can respond better to basic obstetric emergencies such as sepsis, hemorrhage, and shock.
OBJECTIVE: To review the incidence and patterns of near-miss obstetric events (defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy"), as well as studying the classification criteria for near-miss events. METHODS: A prospective observational study was conducted in two tertiary hospitals in Mumbai. Women with near-miss obstetric events were interviewed during the period September 2012-August 2013. RESULTS: There were 884 near-miss events among 877 women, with seven patients readmitted. Clinical-criteria for near-miss events, accounting for 701 (79.3%) cases, were the commonest among the three classifications of near-miss events. Among the cases observed, hypertensive disorders of pregnancy (472 [53.4%]), severe anemia (185 [20.9%]), and postpartum hemorrhage 68 [7.7%]) were the most common causes of near-miss events. The most common problem encountered by patients prior to hospital admission for the near-miss cases was the unavailability of treatment at lower-level health facilities, affecting 598 (68.2%) of the 877 study participants. CONCLUSION:Hypertensive disorders of pregnancy, postpartum hemorrhage, and severe anemia remain important determinants in maternal morbidity. Facilities and training at first-referral units should be improved so that they can respond better to basic obstetric emergencies such as sepsis, hemorrhage, and shock.
Authors: Anke Heitkamp; Anne Meulenbroek; Jos van Roosmalen; Stefan Gebhardt; Linda Vollmer; Johanna I de Vries; Gerhard Theron; Thomas van den Akker Journal: Bull World Health Organ Date: 2021-08-30 Impact factor: 9.408