Evaluation of severe maternal outcomes to assess quality of maternal health care at a tertiary center.
BACKGROUND
Maternal mortality and near-miss index reflect the quality of care provided by a health facility. The World Health Organization recently published near-miss approach where strict near- miss criteria based on markers of organ dysfunction are defined.


OBJECTIVE
The aim of the study was to determine the frequency of severe maternal complications, maternal near-miss cases and maternal deaths, to analyze causes of near-miss and maternal mortality and to determine the values of maternal near-miss indicators.


METHODS
This was a prospective observational study conducted at a tertiary care centre in North India from January 2012 - March 2013. WHO's near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.


RESULTS
The number of women attending our facility with severe maternal complications was low (205 in 6,767 live births); as a result maternal near-miss ratio (MNMR) was low; 3.98/1,000 live births; Overall Maternal near-miss mortality ratio (MNM:1MD) was also low, 3.37:1, because of strict criterion of labeling near-miss and delay in referral to the hospital. Hypertensive disorder (37.5 %) was the commonest underlying cause for maternal mortality.


CONCLUSIONS
Basic implementation of WHO near-miss approach helped in the systematic identification and evidence-based management of severe maternal complications thereby improving the quality of maternal health in a developing country.
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Gupta
G
Sangeeta
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Wadhwa
W
Leena
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Gupta
G
Taru
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Kumari
K
Sushma
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Gupta
G
Nupur
Department of Obstetrics & Gynecology, ESI PGIMSR Basaidarapur, Delhi, India.
Pritam
P
Amrita
Maternal morbidity; Severe maternal outcomes; WHO near-miss approach