title: Maternal near-miss: a multicenter surveillance in Kathmandu Valley.
abstract: BACKGROUND
  Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing Maternal Mortality Ratio is one of the challenges to achieve Millennium Development Goal. The objective was to determine the frequency and the nature of near-miss events and to analyze the near-miss morbidities among pregnant women.
  
  
  METHODS
  A prospective surveillance was done for a year in 2012 at nine hospitals in Kathmandu valley. Cases eligible by deﬁnition were recorded as a census based on WHO near-miss guideline. Similar questionnaires and dummy tables were used to present the results by non-inferential statistics.
  
  
  RESULTS
  Out of 157 cases identiﬁed with near-miss rate of 3.8 per 1000 live births, severe complications were postpartum hemorrhage 62 (40%) and preeclampsia-eclampsia 25 (17%). Blood transfusion 102 (65%), ICU admission 85 (54%) and surgery 53 (32%) were common critical interventions. Oxytocin was main uterotonic used both prophylactically and therapeutically at health facilities. Total of 30 (19%) cases arrived at health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All laparotomies were performed within three hours of arrival. Near-miss to maternal death ratio was 6:1 and MMR was 62.
  
  
  CONCLUSIONS
  Study result yielded similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualiﬁed the recommended standard of care. The near-miss event could be used as a surrogate marker of maternal death and a window for system level intervention.
authors.affiliation: Department of Obstetrics and Gynaecology, Tribhuwan University Teaching Hospital.
authors.forename: Ashma
authors.initials: A
authors.lastname: Rana
authors.affiliation: Department of Obstetrics and Gynaecology, Paropakar Maternity and Women's Hospital.
authors.forename: Gehanath
authors.initials: G
authors.lastname: Baral
authors.affiliation: Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Dangal
mesh_terms: D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration; D008428:Maternal Mortality; D009390:Nepal / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies