Maternal Intensive Care and 'Near-miss' Mortality in Obstetrics

OBJECTIVES - To study various causes of near-misses, and their incidence and influence on overall maternal mortality and to search the level of delay. METHODS- A 'near-miss' describes a patient with acute organ system dysfunction which if not treated appropriately could result in death. A prospective study was conducted on such cases tr eated from January 2001 to June 2001. Their sociodemographic features, causes, modes of management and ultimate outcome w ere evaluated and all maternal deaths during th at period were analysed and compared. RESULTS - One hundred near-misses and 16 maternal deaths were identified. The commonest reason for near-miss were: seve re hypotension (42%), pulmonary edema (23%) and emergencyhysterectomy (10%). The most commoninitiating obstetric conditions were hemorrhage (60%), acute severe hypertension (34%) and sepsis (4%). The primary obstetric factors amongst th e maternal death were: hemorrhage (43.75%),maternal disease (25.09%)and hypertension (18.79%). CONCLUSION - The definition of near-miss identified nearly six times as many cases as maternal deaths. The re view of near-miss mortality helps delineate continuing threats to maternal health and types of support services most commenly required.