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Comparison of near miss obstetric events and maternal deaths in a tertiary care teaching hospital from Eastern India

Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. Timely audit of the obstetrics near miss data would help in reducing maternal mortality.Methods: A retrospective chart review of the maternal near miss (MNM) and death based on WHO 2009 criteria was carried out in a tertiary care teaching hospital from Eastern India over 12 months. Main outcome measures were severe acute maternal morbidity (MNM) and maternal deaths.Results: During the study period, there were 9204 deliveries, 116 near miss cases, and 69 maternal deaths. The MNM incidence ratio was 13.75/1000 live births, MNM to mortality ratio was 1.68:1, and mortality index was 37.3%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hypertensive disorders accounted for the highest number of near miss cases (40.5%), followed by sepsis (31%), haemorrhage (18%), and dystocia (10%). The mortality index was 36.58%, 33.33%, 19.23%, and 07.6% for hypertensive disorders, sepsis, haemorrhage, and dystocia, respectively.  Most common causes of maternal deaths were hypertensive disorders, followed by systemic infections, HELLP syndrome, embolism, haemorrhage, malaria, and ruptured uterus. On bivariate analysis, there was an increased risk of maternal death in those illiterate, incomplete antenatal check-up (<3), multipara, preterm pregnancy, and home delivery.Conclusions: Hemorrhage and hypertensive disorders are the leading causes of MNM events and mortality. Early identification, remedial measures, and timely treatment would help to decrease the burden of maternal near miss and mortality.