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.