Maternal Near-Miss as a Surrogate Indicator of the Quality of Obstetric Care: A Study in a Tertiary Care Hospital in Eastern India

Background Monitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health. Aim and objective The objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. Material and method This study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period. Results During the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission. Conclusion MNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.