Department of Operational Research, Clinical Research, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India.
Department of Biostatistics, Indian Council of Medical Research-National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India.
Indian J Med Res. 2021 Apr;154(4):573-582. doi: 10.4103/ijmr.IJMR_928_19.
BACKGROUND & OBJECTIVES: Maternal morbidity is an indicator of the quality of a country's maternal health services. Maternal near miss (MNM) can provide valuable information in this context and hence these cases need to be reviewed which can indirectly play a major role in reducing maternal mortality ratio in India. The objectives of the present review were to find the prevalence/incidence, criteria used for identification, review the causes of MNM cases and identify the contributory factors responsible for the occurrence of these cases based on three-delay model.
Articles were identified from the PubMed, Google Scholar, Scopus and Cochrane Library using search terms such as 'Maternal Near Miss','maternal morbidity', 'India' among others. All health facility-based observational studies conducted in India published between 2010 to 2019 irrespective of data collection period, and criteria used for identification of MNM cases were included for review. Data were extracted from included studies and summarized in terms of prevalence/incidence, ratio and percentage.
Out of 25 studies, majority were prospective observational conducted at government health facilities. The incidence of MNM varied widely from 3.9 to 379.5 per 1000 live births and 7.6-60.4 per 1000 deliveries. MNM: Maternal Death varied from 1.7:1 to 21.8:1; studies used different criteria to define MNM cases.
INTERPRETATION & CONCLUSIONS: Hypertensive disorders and anaemia were the leading direct and indirect causes of MNM, respectively. There was a lack of uniformity in using the criteria for MNM across studies conducted in India over the last decade. Future studies on MNM in India should follow the uniform criteria mentioned in the MNM-Review guidelines released by the Government of India in 2014 for obtaining systematic data and proper summary estimates.
产妇发病率是衡量一个国家妇幼保健服务质量的指标。产妇严重并发症（Near Miss，MNM）可以为此提供有价值的信息，因此需要对这些病例进行审查，这可以间接在降低印度产妇死亡率方面发挥重要作用。本研究的目的是找出发病率/发生率，用于识别的标准，审查 MNM 病例的原因，并根据三延误模型确定导致这些病例发生的促成因素。
使用诸如“产妇严重并发症”，“产妇发病率”，“印度”等术语，从 PubMed、Google Scholar、Scopus 和 Cochrane Library 中检索文章。纳入 2010 年至 2019 年期间在印度进行的所有基于卫生机构的观察性研究，无论数据收集时间如何，以及用于识别 MNM 病例的标准，都纳入审查。从纳入的研究中提取数据，并以发病率/发生率、比例和百分比的形式进行总结。
在 25 项研究中，大多数是在政府卫生机构进行的前瞻性观察性研究。MNM 的发病率差异很大，从每 1000 例活产 3.9 例到 379.5 例，从每 1000 例分娩 7.6 例到 60.4 例。MNM：孕产妇死亡的比例从 1.7:1 到 21.8:1；研究使用不同的标准来定义 MNM 病例。
高血压疾病和贫血分别是 MNM 的主要直接和间接原因。在过去十年中，印度进行的研究中使用 MNM 标准缺乏一致性。印度未来的 MNM 研究应遵循印度政府在 2014 年发布的 MNM-Review 指南中提到的统一标准，以获取系统数据和适当的汇总估计。
