Abha Singh, Chandrashekhar Shrivastava, Sonal Dube
Department of Obstetrics and Gynecology, Pt. JNM Medical College Raipur, E-8 Shankar Nagar, Raipur, 492001 India.
Department of Obstetrics and Gynecology, Pt. JNM Medical College Raipur, F 7 Block 2 Pt JNM Medical College Campus, Raipur, 492001 India.
J Obstet Gynaecol India. 2016 Oct;66(Suppl 1):217-22. doi: 10.1007/s13224-015-0838-y. Epub 2016 Feb 26.
MMR has always been recognized as an important indicator of quality of health services. The MMR in India has so far not reached up to the required MDG 2015. If we look into this matter with the eagle's eye view, then there are certain gray areas which need attention. For this, it is not the maternal mortality but the maternal near miss which has to be focused.
To audit the maternal near miss in our institution and to review the pathways that lead to severe maternal morbidity and death.
Prospective observational study from September 2013 to August 2015 in Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur. Maternal near miss cases were identified based on WHO criteria 2009, recorded, and studied.
There were 13,895 live births, 211 maternal near miss, and 102 maternal deaths. Maternal near miss to mortality ratio was 2:1. Maternal near miss incidence ratio was 15.18/1000 live births. Mortality index was 32.58 %. Hemorrhage and hypertensive disorders of pregnancy toped the list of the leading causes of near miss morbidity. The near miss events were more common in the primipara (39 %), with age group 21-30 years and in the third trimester at the time of admission.
Auditing maternal near miss can help in reducing their morbidity and mortality in our institution. Similar audit between other institute, state, and countries may help to hasten the slow progress of reducing maternal mortality.
孕产妇死亡率一直被视为卫生服务质量的重要指标。印度的孕产妇死亡率迄今尚未达到2015年千年发展目标的要求。若以敏锐视角审视此事，会发现一些需要关注的灰色地带。为此，应关注的并非孕产妇死亡，而是孕产妇接近死亡情况。
审核本院的孕产妇接近死亡情况，并回顾导致严重孕产妇发病和死亡的路径。
2013年9月至2015年8月在赖布尔的比姆·拉奥·安贝德卡尔纪念医院进行前瞻性观察研究。根据2009年世界卫生组织标准确定孕产妇接近死亡病例，进行记录和研究。
共13895例活产，211例孕产妇接近死亡，102例孕产妇死亡。孕产妇接近死亡与死亡比率为2:1。孕产妇接近死亡发病率为15.18/1000活产。死亡率指数为32.58%。出血和妊娠高血压疾病是接近死亡发病的主要原因。接近死亡事件在初产妇（39%）、年龄21 - 30岁组以及入院时处于孕晚期的产妇中更为常见。
审核孕产妇接近死亡情况有助于降低本院此类病例的发病率和死亡率。其他机构、邦和国家之间开展类似审核可能有助于加快降低孕产妇死亡率的缓慢进程。
