DOI: 10.4103/dypj.dypj_34_25 ISSN: 2347-3665

Maternal Near-Miss, Not to be Missed: A Retrospective Observational Study at a Tertiary Care Center in India

Indrani Mukhopadhyay, Sanjay Singh, Namrata Das, Rima Singh
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Abstract

Objectives:

To determine the prevalence of maternal near-miss (MNM) cases with its associated factors at a tertiary care hospital in Pune, Maharashtra, India.

Materials and Methods:

This retrospective observational study conducted from October 2022 to January 2024 at a tertiary care hospital in Pune, India included women who met World Health Organization criteria for MNM. Data collected from labor wards and intensive care units were analyzed by computing MNM ratios (MNMRs), and mortality indices, and comparing demographic and clinical parameters using chi-square tests and 95% confidence intervals.

Results:

Of 2448 deliveries, 54 cases were MNMs of 22.02 per 1000 live births, two maternal deaths (MDs) (maternal mortality index [MI] – 3.5%), and near-miss to mortality ratio (MR) of 27:1. Most were women aged 30–34 years (35.19%) and multigravida (55.56%). Pearson’s chi-square test revealed that post-cesarean section, threatened abortion, molar pregnancy, retained placenta, twin gestation (all with P < 0.001), and post- in vitro fertilisation embryo transfer pregnancy ( P = 0.002) were significantly associated with adverse maternal outcomes. Hypertensive disorders (51.85%, 28/54) and obstetrical hemorrhages (48.14%, 26/54) were the primary causes of MNM. Blood transfusion was required for 40.74%, with 18.52% (10/54) needing large-volume transfusions, coagulation dysfunction was present in 20.8%, intensive care unit admission in 37.04% (20/54), 5.88% required dialysis, and 7.4% underwent a cesarean hysterectomy.

Conclusion:

Studying MNM cases and their associated factors is crucial for optimizing obstetric care and enhancing preparedness to manage and prevent such incidents. Primigravida, advanced maternal age, hypertensive disorders of pregnancy, and women undergoing cesarean deliveries require meticulous obstetric care and diligent follow-up to ensure the prompt availability of blood and blood products.

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