Abstract

Introduction: Every mother should live beyond pregnancy and childbirth. Why do women die, what could have been done, where did we missed out answers to these and many other questions related to maternal mortality are hidden in the details of the morbidity, because maternal mortality is just the tip of the iceberg with a vast base of near miss morbidity. These situations are much more common than maternal deaths and give more reliable information as women herself can be interviewed. Review of these cases has potential to highlight the deficiencies as well as positive elements in health care system.

Aim: To identify and study SAMM/Near miss cases to assess the reason behind delay in receiving appropriate medical care by using “Three delays model”and to propose an action plan to overcome these problems.  

Methods: It is a Cross sectional study conducted at Department of obstetrics and gynaecology, Government Medical College, Thiruvananthapuram over one year period from July 2014 to June 2015. Data collection was done by in-depth interview of patients and relatives, through pretested questionnaire.

Results: Total 74 Near miss cases and 16 maternal deaths were identified during study period. Mortality index for this study is 0.17 and Maternal Near Miss Mortality Ratio is 4.6:1. More than one delay was involved in most of the cases and multiple factors were involved in most of these delays. Most common delay observed is Type one seen in 54 cases (48.6%). Among this isolated Type one delay in 36 cases, Type one associated with Type two in 16 cases and Type one associated with Type three in 2 cases. Isolated Type two delay observed in 9 cases (12%). Most common cause of Type one delay was inability to judge seriousness of the problem and so that waiting for problem to resolve by itself. Another important cause was lack of deciding person. Most common cause of second delay was lack of deciding or accompanying person. Other important causes were fear of cost and distance, late referral and financial issues. Third delay seen in only 2 cases associated with type one delay were operation theatre was engaged with some other emergency case.

Keywords: Near Miss, Severe Acute Maternal Morbidity (SAMM), Three delays model.

Dr P M Seetha

Professor & Head, Dept of Obstetrics and Gynaecology

Govt Medical College, Parippally, Kerala, India