Management and Identification Features of Near Miss Cases - A Prospective Study

Abstract

Introduction: WHO maternal near miss approach is a standardized method which is implemented in 3 steps i.e. baseline assessment,situation analysis and interventions for improving health care. Hence, present study was undertaken to identify and evaluate the occurrence and causes of severe maternal morbidity i.e. near miss cases. Material and Methods: The present study was conducted in the department of Obstetrics and Gynaecology, Rajindra Hospital, Patiala over a period of one and a half year. The study was conducted on the patients admitted in labour room including referred, emergency and booked admissions. Women with severe complications of pregnancy / labour/ puerperium irrespective of gestational age as per the WHO near miss criteria were identified and studied. Results: Distribution of cases according to clinical criteria include maximum cases of loss of unconsciousness for more than 12 hours i.e. 18.7%, shock 13.8%, clotting failure 13%, respiratory rate <6/min or >40/min in 8.1%, oliguria in 7.3% and jaundice with severe preeclampsia in 5.7% cases. Distribution of near miss cases according to laboratory criteria, and oxygen saturation<90% for >60 min in 14.6% cases. 5.6% cases with acute thrombocytopenia and serum bilirubin >6 mg/dl and serum creatinine >3.5% in 0.8% cases. Conclusion: The need for identifying the patient’s condition and deciding for the referral on time and to the right centre is a critical step towards saving a maternal death. The core of the health system should emphasize on ‘when to refer’ and ‘where to refer’ policy. Referral should be on time so that any untoward incident can be averted and referring a patient to a tertiary care centre where all the emergency back up facilities are available like ICU, 24 hour Blood bank services, apex obstetrical intervention and inter departmental expertise and care. The problem of initial assessment, problem identification, management plan and follow-up of cases depends on a very crucial task of history taking. Keyword: Maternal Health; Maternal Morbidity; Near Miss