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Indicators for maternal near miss: an observational study, India
Divya Mecheril Balachandran1, Dhamotharan Karuppusamy1, Dilip Kumar Maurya1
1Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India.
Bulletin of the World Health Organization
|July 11, 2022
Summary
Comparing maternal near miss criteria in India, the World Health Organization (WHO) and Global Network tools effectively identified severe cases in low-resource settings. Blood transfusion data requires further study for accurate near-miss detection.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Maternal Health
Background:
- Accurate identification of maternal near miss is crucial for improving maternal healthcare.
- Various criteria sets exist, but their applicability in low-resource settings, particularly in India, needs evaluation.
Purpose of the Study:
- To compare the incidence of maternal near miss using the World Health Organization (WHO) near-miss tool against six other criteria sets.
- To assess the utility of these criteria in a low-resource setting in India.
Main Methods:
- A cohort study was conducted in Puducherry, India, from May 2018 to April 2021.
- WHO severity indicators were used to identify women with life-threatening conditions during pregnancy or childbirth.
- Sociodemographic, clinical, and laboratory data were analyzed to calculate near-miss incidence for each criteria set.
Main Results:
- Out of 37,590 live births, 1833 women (4.9%) had life-threatening conditions; 380 had severe maternal outcomes, and 57 died.
- Maternal near-miss incidence varied from 7.6 to 15.6 per 1000 live births across different criteria sets.
- The WHO and Global Network criteria identified all women who died, with Global Network excluding potentially unavailable lab data.
Conclusions:
- The WHO and Global Network criteria are suitable for detecting maternal near miss in low-resource environments.
- Further research is recommended to explore blood transfusion as an indicator, specifying units transfused in low- to middle-income countries.
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