Title: The Burden of Major Obstetric Hemorrhage in Near Miss in a Tertiary Care Centre in Kerala
Authors: Dr Sreekumari Umadevi, Dr Simi Ayesha, Dr Anish Thekkumkara Surendran Nair
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.08
Abstract
Introduction: Near-miss audit it now being increasingly used as a means to assess quality of care given to obstetric population. Major obstetric hemorrhage accounts for the largest proportion of Near misses. By analyzing these cases and identifying pitfalls in management quality of care given to these patients can be improved resulting is further reduction in MMR.
Objective: This study aimed to analyze major obstetric hemorrhage among SMO events during a period of two years from January 2011 to December 2012.
Methods: A cross sectional study was conducted at SAT hospital Government Medical College Thiruvananthapuram, a tertiary care center in South Kerala. All obstetric patients satisfying criteria for near-miss became the study population. Among these those with major obstetric hemorrhage were identified and studied in detail regarding antecedent causes, management options tried, blood and blood products required for therapy. Data were entered in structured proforma and analyzed.
Results: Total live births during this period was 18663. Total 114 cases of severe maternal outcome were identified. Out of these 26 expired and 88 became near-miss. Major obstetric hemorrhage was the cause of severe maternal outcome in 63 (55.26%) cases. Among these acute severe postpartum hemorrhage amounted to 44.73% of SMO and the percentage of atonic PPH was 23.68%. The most common emergency surgical procedure done was emergency laparotomy (22.2%) Hysterectomy had to be done in 44.4% of obstetric hemorrhages. Blood transfusions were given to 95.23% cases. Six cases expired and most common reason was non availability of blood.
Conclusion: Although well-equipped blood banks are a reality for tertiary care centers, first referral units still lack this facility. PPH deaths can be still reduced by strengthening of FRUS.
Keywords: maternal mortality, severe maternal outcome, Near-miss, major obstetric hemorrhage.
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