One-Year Follow-Up of Women with Severe Acute Maternal Morbidity (SAMM): A Cohort Study

  • Shobha A. Alluvala
  • Nuzhat Aziz
  • Ashwin Tumkur
  • Hari K. Boorugu
Original Article



Some women experience unforeseen complications during pregnancy and childbirth, which may be life threatening; their survival depends on intensive support and timely interventions. The aim of this study was to assess the long-term prevalence of adverse health conditions and their impact on quality of life in women who had severe acute maternal morbidity (SAMM).


This is a prospective cohort study comprising 43 women with SAMM during 2015 (exposure group) and 43 women who had an uneventful pregnancy and delivery (non-exposure group) during the same study period. Those who consented were given an additional follow-up date for free medical health check at 1 year.


The incidence of SAMM during study period was 8.6/1000 births. There were five deaths in the exposure group. Adverse health events were seen in 30 (78.94%) out of 38 survivors. Abnormal lipid profile, thrombocytopenia, cardiac diastolic dysfunction, amenorrhoea, Sheehan and Asherman syndrome were major findings in the exposed group. Four (10.52%) women required re-admission, and eight (20.05%) required additional procedures to confirm screening abnormalities. The exposure group had higher mean scores on the EPDS scale, incidence of suicidal thoughts and poorer performance in the WHOQOL BREF psychological domain.


Health programmes need to focus on maternal health, provide medical treatment and psychological support for a longer duration than the traditional 6 weeks postpartum in women who experience SAMM.


Severe maternal morbidity Near miss Follow-up Pregnancy India 



The authors acknowledge and thank all the women who consented to participate in this study.


The Fernandez Hospital Educational and Research Foundation funded this study, for the laboratory and radiological investigations for the study and non-exposure group. The funding agency had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

Authors SAA, NA, AT and HKB declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were done after an informed consent and were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Fernandez Hospital ethical committee (Reg No. ECR/933/Inst/TG/2017) reviewed and approved the protocol (Protocol Ref. No. 32_2014, 19 January 2015 at Fernandez Hospital, Hyderabad, India).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Federation of Obstetric & Gynecological Societies of India 2018

Authors and Affiliations

  • Shobha A. Alluvala
    • 1
  • Nuzhat Aziz
    • 1
  • Ashwin Tumkur
    • 2
  • Hari K. Boorugu
    • 3
  1. 1.Department of ObstetricsFernandez HospitalHyderabadIndia
  2. 2.Consultant Interventional CardiologistFernandez HospitalHyderabadIndia
  3. 3.Consultant PhysicianFernandez HospitalHyderabadIndia

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