Maternal near miss events in India

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.

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.