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Abstract：
BACKGROUND: Maternal mortality is an important indicator to assess the quality of services provided by the health care system. However, maternal near-misses as well as maternal mortality are also indicators of how well the health care system serves pregnant women. To improve our healthcare system in terms of investigative capacity, infrastructure, and personnel, a near-miss registry can provide important information on gaps in pregnancy facilities. This will help us to identify the requirements for referral facility improvements and the need for various health awareness programs. We, therefore, designed this study to analyze the various near-miss events in mothers and compare them with maternal mortality.
METHODS: Present study was conducted in the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (L.L.R.M.) Medical College associated with Sardar Vallabh Bhai Patel (S.V.B.P.) Hospital Meerut, Uttar Pradesh (UP), India for a period of one year and data were collected retrospectively from January 2022 to January 2023. All patients with life-threatening conditions such as excessive bleeding during pregnancy, hypertensive disorders of pregnancy (HDP), and septicemia that occurred during pregnancy or childbirth or within 42 days of termination of pregnancy and required ICU admissions, were included in the study. The total number of deliveries during the study period was 4,360 with 4,333 live births (LB). The total number of eligible cases was 79, out of which 52 were identified as maternal near misses and 27 were maternal mortality. Various maternal mortality and near-miss indices were analysed and statistical analysis was done using the SPSS version 21 (IBM Corp., Armonk, NY, USA).
RESULTS: Our hospital\'s maternal mortality ratio (MMR) was 623/1lakh (0.623%), which is higher than the probability due to the deficiency of appropriate medical services in the nearby areas of western UP. The number of maternal near misses per 1000 LB (maternal near-miss ratio [MNMR]) was 12/1000 LB and the severe maternal outcome rate (SMOR) was 18/1000 LB (1.82%). In our study, hemorrhage and hypertensive disorder in pregnancy were the leading cause of morbidity and mortality followed by sepsis and severe anemia. Among organ dysfunction cardiac illness followed by respiratory dysfunction was the leading cause of morbidity and mortality.
CONCLUSIONS: It is clear that there is a high burden of maternal near-miss in developing countries. There should be the establishment of well-equipped referral units at the periphery with trained manpower. The establishment of obstetrical high-dependence units (HDUs), rapid availability of blood and blood products, training of staff, and availability of multidisciplinary teams can minimize maternal mortality and morbidity.
METHODS: Present study was conducted in the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (L.L.R.M.) Medical College associated with Sardar Vallabh Bhai Patel (S.V.B.P.) Hospital Meerut, Uttar Pradesh (UP), India for a period of one year and data were collected retrospectively from January 2022 to January 2023. All patients with life-threatening conditions such as excessive bleeding during pregnancy, hypertensive disorders of pregnancy (HDP), and septicemia that occurred during pregnancy or childbirth or within 42 days of termination of pregnancy and required ICU admissions, were included in the study. The total number of deliveries during the study period was 4,360 with 4,333 live births (LB). The total number of eligible cases was 79, out of which 52 were identified as maternal near misses and 27 were maternal mortality. Various maternal mortality and near-miss indices were analysed and statistical analysis was done using the SPSS version 21 (IBM Corp., Armonk, NY, USA).
RESULTS: Our hospital\'s maternal mortality ratio (MMR) was 623/1lakh (0.623%), which is higher than the probability due to the deficiency of appropriate medical services in the nearby areas of western UP. The number of maternal near misses per 1000 LB (maternal near-miss ratio [MNMR]) was 12/1000 LB and the severe maternal outcome rate (SMOR) was 18/1000 LB (1.82%). In our study, hemorrhage and hypertensive disorder in pregnancy were the leading cause of morbidity and mortality followed by sepsis and severe anemia. Among organ dysfunction cardiac illness followed by respiratory dysfunction was the leading cause of morbidity and mortality.
CONCLUSIONS: It is clear that there is a high burden of maternal near-miss in developing countries. There should be the establishment of well-equipped referral units at the periphery with trained manpower. The establishment of obstetrical high-dependence units (HDUs), rapid availability of blood and blood products, training of staff, and availability of multidisciplinary teams can minimize maternal mortality and morbidity.
摘要：
背景：孕产妇死亡率是评估医疗保健系统提供的服务质量的重要指标。然而,孕产妇未遂以及孕产妇死亡率也是卫生保健系统为孕妇提供服务的指标。为了在调查能力方面改善我们的医疗保健系统，基础设施,和人员，未遂登记可以提供有关怀孕设施差距的重要信息。这将有助于我们确定转诊设施改进的要求以及对各种健康意识计划的需求。我们,因此,设计了这项研究来分析母亲的各种近错过事件，并将它们与产妇死亡率进行比较。
方法：本研究在妇产科进行，LalaLajpatRai纪念馆（L.L.R.M.）与SardarVallabhBhaiPatel（S.V.B.P.)Meerut医院,北方邦（UP），印度为期一年，数据从2022年1月到2023年1月进行了回顾性收集。所有怀孕期间有大量出血等危及生命的患者，妊娠高血压疾病（HDP），妊娠或分娩期间或终止妊娠后42天内发生的败血症，需要入住ICU，包括在研究中。研究期间的分娩总数为4,360例，有4,333例活产（LB）。符合条件的病例总数为79例，其中52例被确定为孕产妇未遂，27例是孕产妇死亡。分析了各种孕产妇死亡率和近错过指数，并使用SPSS21版(IBMCorp.,Armonk,NY,美国）。
结果：我院孕产妇死亡率（MMR）为623/10万（0.623%），由于西部UP附近地区缺乏适当的医疗服务，这一概率更高。每1000LB（母体近错过比[MNMR]）的母体近错过次数为12/1000LB，严重母体结局率（SMOR）为18/1000LB（1.82％）。在我们的研究中,妊娠出血和高血压疾病是发病率和死亡率的主要原因，其次是败血症和严重贫血。在器官功能障碍中，心脏病和呼吸功能障碍是发病和死亡的主要原因。
结论：很明显，发展中国家的产妇临危负担很高。应该在外围建立装备精良的转诊单位，配备训练有素的人力。建立产科高依赖性单位(HDU)，血液和血液制品的快速供应，员工培训,多学科团队的可用性可以最大限度地降低孕产妇死亡率和发病率。
方法：本研究在妇产科进行，LalaLajpatRai纪念馆（L.L.R.M.）与SardarVallabhBhaiPatel（S.V.B.P.)Meerut医院,北方邦（UP），印度为期一年，数据从2022年1月到2023年1月进行了回顾性收集。所有怀孕期间有大量出血等危及生命的患者，妊娠高血压疾病（HDP），妊娠或分娩期间或终止妊娠后42天内发生的败血症，需要入住ICU，包括在研究中。研究期间的分娩总数为4,360例，有4,333例活产（LB）。符合条件的病例总数为79例，其中52例被确定为孕产妇未遂，27例是孕产妇死亡。分析了各种孕产妇死亡率和近错过指数，并使用SPSS21版(IBMCorp.,Armonk,NY,美国）。
结果：我院孕产妇死亡率（MMR）为623/10万（0.623%），由于西部UP附近地区缺乏适当的医疗服务，这一概率更高。每1000LB（母体近错过比[MNMR]）的母体近错过次数为12/1000LB，严重母体结局率（SMOR）为18/1000LB（1.82％）。在我们的研究中,妊娠出血和高血压疾病是发病率和死亡率的主要原因，其次是败血症和严重贫血。在器官功能障碍中，心脏病和呼吸功能障碍是发病和死亡的主要原因。
结论：很明显，发展中国家的产妇临危负担很高。应该在外围建立装备精良的转诊单位，配备训练有素的人力。建立产科高依赖性单位(HDU)，血液和血液制品的快速供应，员工培训,多学科团队的可用性可以最大限度地降低孕产妇死亡率和发病率。
