title: Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital.
abstract: BACKGROUND
  Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric 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 puerperium, and survives merely by chance or by good hospital care.
  
  
  OBJECTIVE
  The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital.
  
  
  METHODS
  This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit.
  
  
  RESULTS
  During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases.
  
  
  CONCLUSIONS
  The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt.
authors.affiliation: Department of Obstetrics & Gynaecology, Kathmandu Medical College, Sinamangal, Nepal. shresthanira11@gmail.com
authors.forename: N S
authors.initials: NS
authors.lastname: Shrestha
authors.forename: R
authors.initials: R
authors.lastname: Saha
authors.forename: C
authors.initials: C
authors.lastname: Karki
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D009017:Morbidity; D009390:Nepal / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000401:mortality*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*