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

Abstract

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