Maternal Near-Miss: A Multicenter Surveillance in Kathmandu Valley

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. Objective was to determine the frequency and the nature of near-miss (severe acute maternal morbidity) events and analysis of near-miss morbidities among pregnant women.

Methods: Prospective surveillance was done for a year in 2012 in nine hospitals in Kathmandu valley. Cases eligible by definition recorded as a census based on WHO near-miss guideline. Similar questionnaire and dummy tables were used to present the result by non-inferential statistics. 

Results: Out of 157 cases identified with near-miss rate of 3.8, severe complications were PPH (40%) and preeclampsia-eclampsia (17%). Blood transfusion (65%), ICU admission (54%) and surgery (32%) were the common critical intervention. Oxytocin was the main uterotonic used both prophylactically (86%) and therapeutically (76%), and 19% arrived health facility after delivery or abortion. MgSO₄ was used in all cases of eclampsia. All of the laparotomies were performed within 3 hours of arrival. Near-miss to mortality ratio was 6:1 and MMR 62.

Conclusions: Study result yields similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualify the recommended standard of care. The near-miss event can be used as a surrogate marker of maternal death and a window for system level intervention.

 Keywords: abortion, eclampsia, hemorrhage, near-miss, surveillance