Abstract
Objectives
To test the application of a clinical definition of life-threatening complications in pregnancy and determine the level of near miss maternal morbidity and mortality.
Methods
A prospective observational study was conducted in the obstetrics and gynaecology department, NRS Medical College, Kolkata, India, to identify life-threatening complications using a modification of the Mantel’s criteria. The main outcome measures were validity of identification criteria, main causes and incidence of life-threatening complications in pregnancy, maternal near miss: case fatality rates, morbidity–mortality index and use rate of effective interventions.
Results
In total, 177 maternal near miss and 23 maternal deaths were identified in the screened 4400 women. The incidence of near miss was 4.02%. Main causes of maternal mortality were hypertensive disorders (43%) and renal failure (21%). Main causes of near miss were hypertensive disorders (55%), ectopic pregnancy (19%). Near miss mortality index was 7.7:1.
Conclusions
A high proportion of women with life-threatening complications and all women who died were referred from peripheral hospitals. This signals that there may have been important failures in the referral system relating to maternal care and there is a need for further investigation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
WHO, Unicef, UNFPA, and the World Bank estimates. Trends in maternal mortality: 1990 to 2010. Geneva: World Health Organization; 2012.
Millennium development goals India Country report (2015) Ministry of statistics and programme implementation. http://mospi.nic.in/sites/default/files/publication_reports/mdg_2july15_1.pdf. Accessed 4 May 2017.
PAHO/WHO urges countries to take a closer look at life-threatening complications of pregnancy and childbirth (2014). http://www.paho.org/hq/index.php?option=com_content&view=article&id=9651&Itemid=2&lang = en. Accessed 7 Oct 2014.
West Bengal Wikipidia. https://en.wikipedia.org/wiki/West_Benga. Accessed 4 May 2015.
Maternal mortality ratio (MMR) (per 1000 live births) Niti. http://niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births. Accessed 4 May 2015.
Adisasmita A, Deviany PE, Nandiaty F, et al. Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy Childbirth. 2008;8:10.
Lobato G, Nakamura Pireira M, Mendes Sylvia W. Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital. Eur J Obsterics Gynaecol Reprod Biol. 2013;167(1):24–8.
Karolinski A, Mercer R, Micone P, et al. The epidemiology of life-threatening Complications associated with reproductive process in public hospitals in Argentina. BJOG. 2013. https://doi.org/10.1111/1471-0528.12391.
Moraes PA, Barreto SM, AzeredoPasso VM, et al. Incidence and main causes of severe maternal morbidity in São Luís, Maranhão, Brazil: a longitudinal study. Sao Paulo Med J. 2011;129(3):146–52.
Shaheen F, Begum A. Maternal “Near-Miss”. J Rawalpindi Med Coll (JRMC). 2014;18(1):130–2.
Rana A, Baral G, Dangal G. Maternal near-miss: a multicenter surveillance in Kathmandu Valley. J Nepal Med Assoc. 2013;52(190):299–304.
PS R, Verma S, Rai L, et al. Near-miss obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:5. Article ID 393758.
Roy Chowdhury J, Chaudhuri S, Bhattachryya N, Biswas PK, Panpalia M. Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. J Obstet Gynaecol Res. 2009;35(1):119–25.
WHO statement on caesarean section rate World Health Organization (2015). http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf. Accessed 19 May 2017.
Hadad SM, Cecatti JG, Souza JP, et al. Applying the maternal near miss approach for the evaluation of quality of obstetric care: a worked sample from a multicentre surveillance study. Biomed Res Int. 2014;2014:10. Article ID 080815.
Acknowledgements
We are grateful to all women, the doctors, nurses, trainees and other staffs of our hospital without whose collaboration this study would not have been possible.
Author information
Authors and Affiliations
Contributions
Dr. SC was involved in conception and design, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content and final approval of the version to be published. Dr. SN took part in conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content and final approval of the version to be published.
Ethics declarations
Conflict of interest
There was nothing to disclose regarding financial, personal, political, intellectual or religious interests. There is no conflict of interest.
Ethical Approval
The study was conducted after approval by Institutional Ethics Committee of NRS Medical College, and informed consent was obtained before enrolment.
Additional information
Dr. Snehamay Chaudhuri, MD, DNB, is an Associate Professor, Department of Obstetrics and Gynecology, at the NRS Medical College and Department of Obstetrics and Gynecology, at the Midnapore Medical College; Dr. Sumana Nath, MD is a Postgraduate Trainee, Department of Obstetrics and Gynecology at the NRS Medical College and Senior resident, Bankura Samiilani Medical College.
Rights and permissions
About this article
Cite this article
Chaudhuri, S., Nath, S. Life-threatening Complications in Pregnancy in a Teaching Hospital in Kolkata, India. J Obstet Gynecol India 69, 115–122 (2019). https://doi.org/10.1007/s13224-018-1106-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13224-018-1106-8