Prospective observational study of near-miss obstetric events at two tertiary hospitals in Mumbai, Maharashtra, India.
OBJECTIVE
To review the incidence and patterns of near-miss obstetric events (defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy"), as well as studying the classification criteria for near-miss events.


METHODS
A prospective observational study was conducted in two tertiary hospitals in Mumbai. Women with near-miss obstetric events were interviewed during the period September 2012-August 2013.


RESULTS
There were 884 near-miss events among 877 women, with seven patients readmitted. Clinical-criteria for near-miss events, accounting for 701 (79.3%) cases, were the commonest among the three classifications of near-miss events. Among the cases observed, hypertensive disorders of pregnancy (472 [53.4%]), severe anemia (185 [20.9%]), and postpartum hemorrhage 68 [7.7%]) were the most common causes of near-miss events. The most common problem encountered by patients prior to hospital admission for the near-miss cases was the unavailability of treatment at lower-level health facilities, affecting 598 (68.2%) of the 877 study participants.


CONCLUSIONS
Hypertensive disorders of pregnancy, postpartum hemorrhage, and severe anemia remain important determinants in maternal morbidity. Facilities and training at first-referral units should be improved so that they can respond better to basic obstetric emergencies such as sepsis, hemorrhage, and shock.
Department of Operational Research, National Institute for Research in Reproductive Health (ICMR), Mumbai, India. Electronic address: nirrhdor@yahoo.co.in.
Ragini
R
Kulkarni
Department of Operational Research, National Institute for Research in Reproductive Health (ICMR), Mumbai, India.
Sanjay
S
Chauhan
Department of Obstetrics and Gynecology, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
Rekha
R
Daver
Department of Obstetrics and Gynecology, Lokmanya Tilak Municipal General Hospital and Medical College Sion, Mumbai, India.
Yogeshwar
Y
Nandanwar
Department of Infertility and Endocrinology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India.
Anushree
A
Patil
Department of Obstetrics and Gynecology, Lokmanya Tilak Municipal General Hospital and Medical College Sion, Mumbai, India.
Archana
A
Bhosale
D000328:Adult; D000740:Anemia / Q000150:complications / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D062606:Tertiary Care Centers
Clinical; Criteria; Dysfunction based; Hospitals; Management based; Near miss; Observational; Organ system