Title:Assessment of Organ Dysfunction and Underlying Causes in Maternal
Near-miss Cases at Health Care Facilities in Doiwala Block of District
Dehradun – A Retrospective Study
Volume: 19
Issue: 3
Author(s): Dhanak Kanwar, Jaya Chaturvedi, Mahendra Singh, Pradeep Aggarwal*, Nandita Sharma and Sabiha Sadiq
Affiliation:
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
Keywords:
Mortality, obstetric, WHO maternal near-miss tool, severe acute maternal morbidity, SDG target, COVID-19 pandemic.
Abstract:
Introduction: The extent of maternal morbidity is a good gauge of a nation's maternal
health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly
contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide
useful information in this context. Such women who survive these life-threatening conditions arising
from complications during pregnancy, childbirth and post partum (42 days) share many commonalities
with those who die because of such complications.
Aim: To assess the organ dysfunction and the underlying causes, associated/contributory factors associated
with “maternal near-miss” cases in pregnant, in labor, post-partum women (upto42 days) in
the health care facilities of Doiwala block, district Dehradun.
Materials and Methods: The present study was conducted over a period of 6 months under the Department
of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh.
The cross-sectional study included the medical record files of all pregnant women attending the Department
of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district
Dehradun.
This study was conducted as per the WHO criteria for “near-miss” by using convenience sampling
for the selection of healthcare facilities. The medical record files of all women who were pregnant,
in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 –
31.05.2022.
Results: It was found that Out of the women with maternal near-miss (n=91), the majority of women
had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction
(n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%).
Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ
dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric
hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders
(n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had
pregnancy-related infection.
It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was
Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63,
69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%).
Conclusion: Pregnancy should be a positive experience for every woman of childbearing age. A
better understanding of pregnancy-related conditions enables early detection of complications and
prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes
with long-term health implications or death. There are already effective measures in place to
reduce maternal and newborn mortality and morbidity.
