Study of Maternal Near Miss by Near Miss: Mortality Ratio, Exploring Quality of Care

Abstract

Introduction: Near Miss being a proxy indicator of MMR, evaluation of facility services and Near Miss
numbers was carried out in a teaching hospital in Central India. Sustainable Development Goal targets
MMR less than 70 by year 2030. This study aims to report and evaluate causal factors of maternal near
miss ratio, maternal death ratio as it is a sensitive indicator of medical care given by the facility. Critical
care services were quantified in this study.
Methods: 4422 number of delivery files occurring over a period of 3 years were included in a
retrospective manner. Maternal deaths were 21, Near Miss 170 and live births 4237. Variables studied
were Maternal near miss ratio, Maternal near miss mortality ratio, mortality index and final diagnosis
of each patient. The number of blood components, urgent surgery, ventilator, ICU stay, dialysis and
number of fourth-generation antibiotics were studied for calculating risk factors against various
diagnoses. Bi-variate analysis and percents were statistical tools used.
Results: Maternal near miss ratio was 40.12, the maternal near miss mortality ratio 8.09:1, and mortality
index 10.99%. The findings included 85.3% blood transfusion use, 61.8% surgical intervention, 38.2%
inotrope, 32.4% ventilator, 96% ICU and 96% fourth generation antibiotic use. Odds for comparison
of services given for various different etiological conditions with respect to MNM ratio and MNMMortality
ratio was statistically significant for our data; giving a positive and better ranking to services
in this Institute.
Conclusion: The maternal near-miss ratio of 40.12, Mortality index of 10.99% and MNM – Mortality
ratio 8:1 are the major findings of this study.Odds for comparative statements between other reports
and others showed statistical significance.