Publication: Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
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.
Objectives: 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.
Material and 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.
Conclusion: 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.
Key words: Near-miss obstetric morbidity, Maternal mortality, Five factor scoring system
Description
Shrestha NS 1, Saha R 1 , Karki C2
1 Assistant Professor, 2Head and Professor, Department of Obstetrics & Gynaecology, Kathmandu Medical College, Sinamangal, Nepal