“Maternal Severity from Survival to Death: Gamma Regression Analysis of WHO Organ Dysfunction Markers in South India”

Background: Maternal mortality alone underestimates the burden of severe obstetric complications, as many women survive life-threatening events with significant organ dysfunction.The WHO maternal near-miss framework provides a severity-based assessment for better understanding extreme maternal morbidity and care quality.This study examined associations between organ dysfunction-based severity markers and maternal death, modelling severity from near miss to death. Methods:A cross-sectional study conducted at a South Indian tertiary referral hospital (February 2024-January 2025) included all pregnant and postpartum women within 42 days who met WHO near-miss criteria or experienced death.Associations were assessed using relative risks (RR) with 95% confidence intervals.A generalized linear model with a log link and a gamma distribution was used to assess severity scores.Results: Of 4,068 deliveries, 206 had severe outcomes (191 near misses, 15 deaths).Highest mortality is linked to cardiopulmonary resuscitation (82.4%;RR 154.8), intubation/ventilation (45.5%;RR 289.4), shock (24.1%;RR 35.7), severe hypoxemia (50.0%;RR 11.8), oliguria unresponsive to fluids (66.7%;RR 29.2), and dialysis (40.0%;RR 9.3).Hemorrhage (6.9%) and massive transfusion (11.1%) were common but not significantly associated with death.Deaths rose from severity scores 5, with none surviving 7.Gamma regression showed multiorgan dysfunction as the strongest severity predictor. Conclusion: Organ dysfunction-based assessment captures the full spectrum of severe maternal outcomes beyond mortality.Integrating these indicators into obstetric care and health J o u r n a l P r e -p r o o f 2 systems enables early risk detection, timely interventions, and improved maternal health monitoring.