Life-threatening Complications in Pregnancy in a Teaching Hospital in Kolkata, India
To test the application of a clinical definition of life-threatening complications in pregnancy and determine the level of near miss maternal morbidity and mortality.
A prospective observational study was conducted in the obstetrics and gynaecology department, NRS Medical College, Kolkata, India, to identify life-threatening complications using a modification of the Mantel’s criteria. The main outcome measures were validity of identification criteria, main causes and incidence of life-threatening complications in pregnancy, maternal near miss: case fatality rates, morbidity–mortality index and use rate of effective interventions.
In total, 177 maternal near miss and 23 maternal deaths were identified in the screened 4400 women. The incidence of near miss was 4.02%. Main causes of maternal mortality were hypertensive disorders (43%) and renal failure (21%). Main causes of near miss were hypertensive disorders (55%), ectopic pregnancy (19%). Near miss mortality index was 7.7:1.
A high proportion of women with life-threatening complications and all women who died were referred from peripheral hospitals. This signals that there may have been important failures in the referral system relating to maternal care and there is a need for further investigation.
KeywordsLife-threatening complications Obstetric near miss Maternal mortality Severe maternal morbidity Severe acute maternal morbidity
We are grateful to all women, the doctors, nurses, trainees and other staffs of our hospital without whose collaboration this study would not have been possible.
Dr. SC was involved in conception and design, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content and final approval of the version to be published. Dr. SN took part in conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content and final approval of the version to be published.
Compliance with Ethical Standards
Conflict of interest
There was nothing to disclose regarding financial, personal, political, intellectual or religious interests. There is no conflict of interest.
The study was conducted after approval by Institutional Ethics Committee of NRS Medical College, and informed consent was obtained before enrolment.
- 1.WHO, Unicef, UNFPA, and the World Bank estimates. Trends in maternal mortality: 1990 to 2010. Geneva: World Health Organization; 2012.Google Scholar
- 2.Millennium development goals India Country report (2015) Ministry of statistics and programme implementation. http://mospi.nic.in/sites/default/files/publication_reports/mdg_2july15_1.pdf. Accessed 4 May 2017.
- 3.PAHO/WHO urges countries to take a closer look at life-threatening complications of pregnancy and childbirth (2014). http://www.paho.org/hq/index.php?option=com_content&view=article&id=9651&Itemid=2&lang = en. Accessed 7 Oct 2014.
- 4.West Bengal Wikipidia. https://en.wikipedia.org/wiki/West_Benga. Accessed 4 May 2015.
- 5.Maternal mortality ratio (MMR) (per 1000 live births) Niti. http://niti.gov.in/content/maternal-mortality-ratio-mmr-100000-live-births. Accessed 4 May 2015.
- 10.Shaheen F, Begum A. Maternal “Near-Miss”. J Rawalpindi Med Coll (JRMC). 2014;18(1):130–2.Google Scholar
- 11.Rana A, Baral G, Dangal G. Maternal near-miss: a multicenter surveillance in Kathmandu Valley. J Nepal Med Assoc. 2013;52(190):299–304.Google Scholar
- 12.PS R, Verma S, Rai L, et al. Near-miss obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:5. Article ID 393758.Google Scholar
- 14.WHO statement on caesarean section rate World Health Organization (2015). http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf. Accessed 19 May 2017.
- 15.Hadad SM, Cecatti JG, Souza JP, et al. Applying the maternal near miss approach for the evaluation of quality of obstetric care: a worked sample from a multicentre surveillance study. Biomed Res Int. 2014;2014:10. Article ID 080815.Google Scholar