Severe maternal morbidity and maternal near miss in a tertiary hospital of Delhi

Background. In addition to maternal mortality, information on maternal near miss and severe maternal morbidity are important in maternal healthcare. We aimed to determine the incidence, causes and outcome of severe maternal morbidity and near miss, and the sociodemographic and obstetric factors associated with these at a tertiary care teaching hospital in Delhi. Methods. Women admitted with severe maternal morbidity and near miss, as defined by the WHO study group, were included in the study. The incidence ratio of near miss and severe morbidity in the hospital was determined, and a case-control study was conducted to study the factors associated with the occurrence of near miss. Information was obtained from hospital records and interviews, using a semi-structured open-ended questionnaire. Results. The incidence ratio of near miss was 6.85/1000, and severe morbidity was 11.38/1000 live births. Hypertensive disorders and haemorrhage were the common causes of cases of near miss and severe morbidity. Coagulation dysfunction (62%) was the most common organ dysfunction, followed by uterine dysfunction (22%). Older age (odds ratio [OR] 2.01, confidence interval [CI] 1.02-3.93), the absence of formal education (OR 2.05, CI 1.11-3.75), <18 years of age at marriage (OR 2.01, CI 1.21-3.32), lower income (OR 3.8, CI 1.88-7.64), gravida of four or more (OR 2.25, CI 1.21-4.17) and residence outside Delhi (OR 9.31, CI 4.36-19.90) were significant predictors of near miss. Sepsis, hypertensive disorders and haemorrhage were the most common underlying conditions in women who died. The foetal outcome was a live birth in 64% of near-miss cases and 62% among severe morbidity. Conclusions. The burden of severe maternal morbidity and near miss is high. These need to be identified and managed at the earliest.