Validating the maternal near miss review operational guidelines for teaching institutes in India: A retrospective five-year study

Background & objective The World Health Organization working group defined maternal near miss (MNM) as women who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Our objective was to investigate the incidence of MNM events, identify the associated risk factors, and evaluate their outcomes. Additionally, we aimed to validate the MNM Review Operational Guidelines by the Ministry of Health and Family Welfare (MOHFW), Government of India, as a tool for medical colleges for MNM audits. Methods A five-year retrospective cohort analysis was conducted in the department of Obstetrics and Gynaecology at a tertiary care teaching hospital. The study included 324 patients who were hospitalized over these five years and met the inclusion criteria of the MOHFW MNM operational guidelines. Results Our audit over five years revealed a maternal near-miss incidence ratio (NMIR) of 46.6 per 1,000 live births and a near-miss rate (NMR) of 44.6 per 1,000 obstetric admissions. Among the identified MNM cases, haemorrhage was the most common condition leading to MNM events, accounting for 250 out of 324 cases (77.1 %). Interpretation & conclusions The MNM cases act as an indirect marker of the quality of maternal healthcare services. Using a common operational guideline for monitoring MNM cases will simplify data reporting and streamline documentation across all teaching institutes, allowing meta-analysis of nationwide data in the future.