Hospital-Based Multidisciplinary Postnatal Care for Holistic Maternal Recovery: A Collaborative Assessment of Long-Term Outcomes after Maternal Near Miss.

Abstract

Background: Maternal near-miss (MNM) survivors face unique long-term reproductive, sexual, and mental health challenges.

Aim: This study compared MNM survivors with women who had uncomplicated deliveries.

Methods: A cross-sectional study was conducted among 75 MNM women and 150 age-matched controls with uncomplicated delivery at a tertiary care center in North India. Recruitment was carried out at least 1 year after the life-threatening event and at most within 2 years of the event. Reproductive capacity, menstrual resumption, contraception use, sexual function (FSFI), and mental health (GAD-7, PHQ-9) were assessed one year post-delivery.

Results: Forty percent of MNM women underwent peripartum hysterectomy, resulting in a significant loss of reproductive capacity compared to controls (42.7% vs. 6.7%; p < .001). The mean time to resumption of menses was shorter in the MNM group (3.10 ± 2.29 months vs. 3.93 ± 3.15 months; p = .04). Menstrual irregularity and secondary amenorrhea were more common among MNM survivors. The desire for future pregnancy was lower among cases (13.9% vs. 25%, ANCOVA p = .02). Contraception use was comparable, but the duration of continuous use was significantly longer in MNM women (12.5 vs. 7.1 months; p < .001). FSFI total scores were similar between groups, but MNM women had lower satisfaction and desire scores after adjusting for confounders. Anxiety (24% vs. 6%) and mean depression scores (2.28 vs. 1.70; p = .02) were significantly higher in the MNM group.

Conclusion: MNM survivors experience significant loss of reproductive potential, altered fertility intentions, extended contraception use, sexual dissatisfaction, and higher anxiety. Integrated reproductive, sexual, and mental health services are needed to address these unmet needs in MNM survivors.