ABSTRACT
Introduction: WHO maternal near miss approach is astandardized method which is implemented in 3 steps i.e.baseline assessment,situation analysis and interventions forimproving health care. Hence, present study was undertakento identify and evaluate the occurrence and causes of severematernal morbidity i.e. near miss cases.Material and Methods: The present study was conductedin the department of Obstetrics and Gynaecology, RajindraHospital, Patiala over a period of one and a half year. Thestudy was conducted on the patients admitted in labourroom including referred, emergency and booked admissions.Women with severe complications of pregnancy / labour/puerperium irrespective of gestational age as per the WHOnear miss criteria were identified and studied.Results: Distribution of cases according to clinical criteriainclude maximum cases of loss of unconsciousness formore than 12 hours i.e. 18.7%, shock 13.8%, clotting failure13%, respiratory rate <6/min or >40/min in 8.1%, oliguria in7.3% and jaundice with severe preeclampsia in 5.7% cases.Distribution of near miss cases according to laboratorycriteria, and oxygen saturation<90% for >60 min in 14.6%cases. 5.6% cases with acute thrombocytopenia and serumbilirubin >6 mg/dl and serum creatinine >3.5% in 0.8% cases.Conclusion: The need for identifying the patient’s conditionand deciding for the referral on time and to the right centre isa critical step towards saving a maternal death. The core ofthe health system should emphasize on ‘when to refer’ and‘where to refer’ policy. Referral should be on time so that anyuntoward incident can be averted and referring a patient to atertiary care centre where all the emergency back up facilitiesare available like ICU, 24 hour Blood bank services, apexobstetrical intervention and inter departmental expertise andcare. The problem of initial assessment, problem identification,management plan and follow-up of cases depends on a verycrucial task of history taking.
ABSTRACT
Background: Effective implementation of the near-miss concept will help analyze the high-risk group and strengthen the entire healthcare setup for enabling favorable outcome.The present study aims to assess the features of near-miss obstetric cases reporting to government tertiary hospital in order to propose significant interventions to save the high risk group of patients. Methods: The present study was conducted among patients admitted in labour room including referred, emergency and booked admissions. Women with severe complications of pregnancy / labour/ puerperium irrespective of gestational age as per the WHO near miss criteria were identified and studied. The first step in implementing the near-miss approach was to systematically identify women with severe complications of pregnancy. Results: Most common direct complicating factor being hemorrhage 26%, eclampsia 18.7%, sepsis 9.8%, rupture uterus 4% (rupture uterus was present in 2 cases of grandmultipara and 3 cases had more than 2 previous LSCS) and obstructed labour 3.2%. Among the indirect causes anaemia 34.1% was leading cause. Out of this iron deficiency anaemia was seen in 88% cases and 12% cases had other types of anaemia like megaloblastic and thalassemia minor. Respiratory disease 4%, liver disease 5.7% (mainly hepatic encephalopathy) and heart disease 1.6% (1 patient had dilated peripartum cardiomyopathy and 1 patient was revived from sudden cardiac arrest). Conclusion: The most common direct cause for maternal near miss is hemorrhage. Although hemorrhage is the leading cause of maternal death worldwide but postpartum hemorrhage is highly unpredictable and poses a major challenge to obstetricians. Eclampsia and severe preeclampsia are one of the easiest identifiable and avoidable factors for preventing maternal death. Health care providers like ASHA workers and ANMs who have first contact with the antenatal women should be trained to tally and read the dipstick test results and inform the doctor accordingly.