Clinical Spectrum and Fetomaternal Outcomes in Near Miss Patients Presenting to a Tertiary Care Hospital

Abstract

Background and Objectives: Maternal near miss events are life threatening obstetric conditions which need urgent medical help in order to prevent maternal death. Audit of near miss events is a surveillance tool which is used to assess the quality of antenatal care in a setting and help in identifying causes to improve the maternal outcome. The objective was to find out the frequency, clinical spectrum and fetomaternal outcome in near miss patients presenting to a tertiary care hospital.
Methods: This was case-series observational study, conducted in Lady Willingdon Hospital, Lahore from January 2022 to December 2022. Eighty women were included. Each case was analyzed regarding age, gestational age, parity, examination findings, laboratory diagnosis, management plan, feto-maternal outcome, level of post-operative care, number of blood transfusions and complications.
Results: Most patient's were from age bracket 30-40 years, gestational age 28-36 weeks, parity P2-P4. The leading causes of near miss events were hemorrhage (48.75%), followed by hypertensive disorders (31.25%), viral hepatitis (8.75%), uterine rupture (6.25%), sepsis (5%) and ruptured ectopic pregnancy (3.75%). As maternal outcome, there were four deaths. Our fifty-eight patients (72.5%) required regular level-1 care, eighteen patients (22.5%) required high dependency unit level-2 care and four patients (5%) required intensive care unit level-3 care. Seventy-one babies were delivered. Sixty-one were born alive while ten were still born. Neonatal ICU admissions were twenty-seven, out of these twenty-two were discharged from nursery and early neonatal deaths were five.
Conclusion: Near miss events, if treated timely at well-equipped facility may prevent progression to life threatening situations.
Keyword: Near miss events, hemorrhage, hypertension, antenatal care