MATERNAL NEAR MISS PATIENTS IN RURAL TERTIARY CARE CENTER - CLINICALAND SOCIAL FACTORS

Maternal deaths are merely the tip of the iceberg. The broad base of this iceberg represents the maternal near miss patients. This has emerged as an adjunct to investigation of maternal deaths as the two have similar pathological and circumstantial factors. These cases help us analyse and prevent obstetrical catastrophes. Aim: To assess the various complications leading to maternal near miss at rural tertiary care center in Maharashtra, to evaluate the socio-economic and clinical characteristics involved in these patients. Objective- To record the condition of the near-miss patients during admission, their mode of delivery, the primary cause and the key interventions used. Method: A prospective observational type of Study Design used and we conducted a study in a tertiary care centre of Maharashtra for 19 months from December 2022 to June 2024. All pregnant women of reproductive age group attending Obstetrics and gynaecology department of our hospital with diagnosis of near miss according to the WHO maternal near miss criteria and who followed up were included. Results: A total of 102 cases of near miss & 14 maternal deaths were observed. The Maternal near miss Mortality ratio was 7.3:1. 47% cases were between age 21 - 25 years. 47% were primigravida. 86.3% reside in rural areas. Majority cases were from lower or lower middle socioeconomic classes. 21.6% were illiterate while 60.8% were educated up to primary level. 72.5% were referred cases. 40% of mothers had inadequate antenatal checkups. Major socio-economic factors for Probable MNM seen in present study were: lack of accessibility of hospital (71%), Inability of understand the problem (67%). Most common etiology for maternal near miss was hypertension disorders (40.2%) followed by hemorrhage and medical complication (22.5%). LSCS was required in 58.8%. Most cases had hospital stay between 7 to 14 days (84.3%). ICU stay was seen for 1 to 3 days in 90.2% cases. Blood Transfusion was done in 62.7% cases. Conclusion: Present study showed the common etiologies, interventions, common socio-economic factors of near-miss cases. The addition of near-miss audits allows the care of critically ill women to be analyzed, deficiencies in the provision of care to be identified, and comparisons within and between institutions and countries to be carried out over time. This will improve the quality of obstetric care and further reduce maternal morbidity and mortality.