A retrospective 2 year study of maternal near miss cases, a standard tool for monitoring quality of maternal health care in a tertiary care centre of south east Rajasthan

Abstract

Aim: To evaluate maternal near-miss (MNM) cases as a standard tool for monitoring the quality of maternal healthcare in a tertiary care centre of Southeast Rajasthan using NRHM 2014 criteria.

Methods:  This retrospective observational study was conducted over a two-year period from April 2022 to March 2024 at SHKBM Hospital, Jhalawar Medical College, Rajasthan. Critically ill pregnant, labouring, postpartum, and post-abortal women fulfilling NRHM 2014 maternal near-miss criteria were included. Data were collected from ICU records, inpatient case files, and referral documents. Demographic profile, obstetric characteristics, causes of near-miss, delays in care, interventions, and maternal and fetal outcomes were analysed.

Results: A total of 188 maternal near-miss cases were identified, with an incidence ratio of 10.42 per 1000 live births. Most women were aged 18–23 years (51.6%), multiparous (55.3%), and presented after 28 weeks of gestation (79%). The majority belonged to a lower socio-economic class (88.8%). Hemorrhage (64.2%) and hypertensive disorders (28.2%) were the leading causes of near-miss events. Lower-segment cesarean section was the most common mode of delivery (44%). The maternal mortality ratio was 255 per 100,000 live births, and the mortality index was 19.65%.

Conclusion: Maternal near-miss analysis is a sensitive indicator of obstetric care quality. Most near-miss events were associated with preventable factors such as delayed care-seeking, inadequate antenatal care, and referral delays. Strengthening emergency obstetric services, improving antenatal coverage, and enhancing community awareness are essential to reduce severe maternal morbidity and mortality.