Management and Identification Features of Near Miss Cases - A Prospective Study

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.