A Prospective Study of Severe Acute Maternal Morbidity and Maternal Near Miss in a Tertiary Care Hospital.

Background: The identification of severe cases of maternal morbidity has emerged as an approach to mitigating maternal deaths. The main objective of the study was to analyse the causes of (severe acute maternal morbidity) SAMM and maternal (near miss) NM among pregnant women and the associated risk factors. Methods: The study was conducted on pregnant women (n = 300) who were diagnosed as SAMM (n = 269) and NM (n = 31). Patient details including age, parity, gestational age at admission, antenatal history, morbidity conditions, mode of delivery, and ICU admission with life-saving medical and surgical interventions were recorded. Multinomial logistic regression analysis was performed to assess the risk factors associated with SAMM and NM. Results: The most common cause of maternal death was hemorrhage. The maternal NM incidence ratio was 11.58/1000 live births, maternal NM mortality ratio was 2.5:1, and the mortality index was 3.8% with SAMM and NM and 27% with life-threatening complications.Women with low education status, multiparity, third trimester and postpartum period, suboptimal antenatal visits, and a lack of awareness were at increased risk of SAMM and NM. Conclusion: This study adds on to the existing knowledge of SAMM and NM highlighting the need of early diagnosis and need of overall improvement in quality critical care management for maternal health and its timely accessibility to substantially reduce maternal deaths. Active management of third-stage of labor, early recognition and emergency management of severe hypertension widely contribute toward reducing the number of both SAMM and NM.