Raffat Sultana, Azra Jameel, Aneela Amjad.
Obstetrical Near Miss and maternal deaths at district hospital Karachi, Pakistan.
Pak J Surg Jan ;30(3):272-8.

Background: Maternal Mortality has been used as an indicator of maternal death all over the world for a long time. More recently review of the cases with Near Miss obstetrics events has been found to be useful to investigate maternal mortality. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery or the peurperium & survive by good hospital care at right time. Aims: Th e aim of the study is to determine the prevalence & nature of near miss obstetric cases & maternal deaths at Sindh Government Qatar Hospital Karachi. Methods: Th is is a descriptive study conductive for a period of 13 months from 1st January 2010 to 31st January 2011. Cases of severe maternal morbidity & mortality were identifi ed during daily morning meeting & weekly perinatal meetings. Near miss cases were defi ned based on any validated disease specifi c criteria (Fillipi 2005) including haemorrhage, hypertensive disorder in pregnancy, dystocia, infection & anemia. Th e near miss morbidities were compared with maternal death with respect to demographic features & disease profi les. Main outcome were included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices & proportion of near miss cases & mortality cases to hospital admission. Results: During this study 7238 women delivered at the institute & 81 women were identifi ed as near miss cases. Th e prevalence of near miss cases in this study was 1.11%. 15 maternal deaths were occurred during this period, resulting in a ratio of 207.2 maternal deaths per 100,000 live births. Hypertensive disorders in pregnancy & hemorrhage were responsible for 60.3% of near miss cases & 79.9% of maternal death. In this study severe anemia was the 3rd leading cause of near miss cases & responsible for 22.2% cases & maternal deaths caused by severe anemia is 13.3%. Eclampsia has the highest mortality index of 40%, followed by postpartum haemorrhages (31.25% MI) & uterine rupture MI 25%. Most case (83.9) were unbooked & referred in critical condition. Th e overall maternal death to near miss ratio is 1:5.4. Conclusions: Th e major causes of near miss cases were similar to the causes of maternal mortality. Near miss analysis provides valuable information on obstetric case. Th e study highlights the need to improve antenatal care for early identifi cation of high risk pregnancies. It also emphasizes on improving the resources for managing severe morbidities due to hypertension & haemorrhage, especially in critically ill unbooked patients. An urgent review of referral system is highly required.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com