Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357

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Original Research Article

A review of maternal near miss events in a tertiary teaching hospital- A tool for
improving quality of obstetric care in developing countries: A descriptive study
Smita Thakkarwad 1 , Mangal Supe 1 , Suryakant Mundlod 2, Mahesh Asalkar 1 *,
Ravikiran Bacchewad 1 , Shweta Puri 1 , Sinchana Ramesh 1

1 Dept. of Obstetrics and Gynaecology, Yashwantrao Chavan Memorial Hospital, Pune, Maharashtra, India
2 Dept. of Paediatrics, Yashwantrao Chavan Memorial Hospital, Pune, Maharashtra, India

ARTICLE INFO ABSTRACT

Article history: Background: In 2015, the United Nations Member States adopted the Sustainable Development Goals
Received 28-02-2024 (SDGs), which include reducing the maternal mortality (MM) ratio by two-thirds by 2030. Maternal
Accepted 18-04-2024 mortality rates are alarming, especially in low-income countries where 99% of all maternal deaths occurs.
Available online 20-08-2024 Maternal Near Miss event was described by the World Health Organization (WHO) as “A woman who
is close to death survived a complication that occurred during pregnancy, delivery or up to 42 days of
termination of pregnancy.” This concept was launched in the health system. Maternal near-miss audit was
Keywords: recognized as a useful tool to improve the quality of obstetric care.
Maternal near miss Materials and Methods: A descriptive study was conducted at PCMC’s Postgraduate Institute and YCM
Near miss audit
Hospital Pimpri Pune (Maharashtra) from 1st January 2020 to 30 June 2021. During the study period,
Maternal mortality
Maternal Near miss (MNM) cases were identified as per WHO criteria for enrolment. This study reviewed
Mortality index near-miss cases with aim to study baseline assessment, to analyse cause and intervention to improve health
cases.
Results: Of total 9534 admissions, 130 mothers had severe maternal outcomes (114 maternal near-miss
cases and 16 maternal deaths). 104(91.23%) MNM cases were between the ages of 20-35 years, 72.13%
were from rural, 78(68.42%) were referred from health [Link] two(63.86%) were multigravida.
Sixty Nine (60.53%) had hypertension in pregnancy followed by 62 (54.39%) had haemorrhage.
Conclusion: Our study concluded hypertension in pregnancy and haemorrhage are major causes of MNM
cases. ICUs and blood banks play a pivotal role in the prevention of maternal mortality. Developing
countries should aim to improve maternal health outcome by improving HDU/ICU facilities and blood
bank to reduce maternal mortality.

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1. Introduction psychological and social effects on women.

Maternal Near Miss event was described by the World Hence, the concept MNM review was launched in the
Health Organization (WHO) as “A woman who, is close health system. 2
to death but survived a complication that occurred during MNM cases are more prevalent than the maternal death.
pregnancy, delivery or up to 42 days of termination For every maternal death, there are approximately 100
of pregnancy.” 1 MNM event is related with emotional, MNM. 3 Maternal near misses (MNM) are more reachable
and truer as the woman is herself a source of facts. So,
* Corresponding author. a review of MNM cases generates precious information
E-mail address: mahesh@[Link] (M. Asalkar). regarding severe life-threatening conditions, which timely

[Link]
2394-2746/© 2024 Author(s), Published by Innovative Publication. 351
352 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357

not intervene may result in maternal mortality. 4 2.4. Statistical analysis

Maternal mortality rates are still alarmingly high, Statistical analysis was conducted using Epi-info 7
especially in low-income countries where 99% of all software.
maternal deaths occur. Developing countries have a risk of
maternal mortality one in 41 live births, while developed
2.5. Data collection
countries have a risk of one in 3300 live births. 5 The
majority of maternal deaths (66%) occur in Sub-Saharan Data was collected by resident doctors in a consistent,
Africa, with Southern Asia contributing 22%. 6 The primary uniform, and reliable manner using a standard proforma
reason for this disparity is a lack of access to quality care throughout the week and this was reviewed by the faculty
during pregnancy, childbirth, and the postnatal period. 5,7 on every Saturday. Key variables, as mentioned in the data
In 2015, the United Nations Member States adopted collection tool, were documented.
the Sustainable Development Goals (SDGs), which include The following are the parameters that were considered in
reducing the maternal mortality (MM) ratio by two-thirds by data collection tool for the study:
2030, ultimately aiming to eliminate preventable maternal
deaths. 8 1. Demographic parameter: Age criteria, Education,
Place, Socio-economic status.
2. Obstetric score: Gravida, Parity.
2. Materials and Methods
3. Diagnostic spectrum: Haemorrhage, Hypertension,
This descriptive study was conducted at PCMC’s Anaemia, and other related conditions.
postgraduate institute and YCM hospital, Pimpri Pune 4. Organ dysfunction: Cardiovascular, Respiratory,
(Maharashtra) from January 1st 2020 to June 30t h 2021. Hematologic.
Study was intended to review MNM cases to analyse causes 5. Critical Interventions: Blood transfusions, ICU
and evaluate interventions for improving maternal health admission, Surgical interventions, etc.
outcome of MNM cases and to estimate maternal near miss 6. Near miss indicators: SMOR, MNMR, MI.
indicators. During this study period, MNM cases were 7. SMOR (Severe maternal outcome Ratio) (MNM +
prospectively identified and enrolled. MD) / 1000 live births (LB).
Our institute is a tertiary level hospital in public sector 8. Maternal near miss ratio (MNMR) - (MNM/1000 live
providing 150-200 obstetric outpatient services daily while births)
conducting 28-34 deliveries per day with availability of 9. MNM mortality ratio (MNM MR) - (MNM per 1
emergency facilities , Intensive Care Unit (ICU) and blood maternal death)
transfusion round the clock. 10. Mortality index(MI) – MD / MNM + MD

Aberrations : – MD maternal death ; LB livebirths ; MNM

2.1. Inclusion criteria maternal near miss
All cases fulfilling WHO inclusion criteria for MNM were Inclusion criteria for identifying near miss cases of
enrolled. maternal health according to WHO:
Severe maternal complications that require critical
interventions or admission to the intensive care unit,
2.2. Exclusion criteria including:
MNM cases turning out into maternal mortality cases were
1. Severe postpartum hemorrhage
excluded. Also, participation was denied in the near-miss
2. Severe pre-eclampsia or eclampsia
cases.
3. Sepsis or severe systemic infection
Technique/Methodology: Informed consent was obtained 4. Ruptured uterus (excluding caesarean section)
from MNM cases that were admitted and included in the 5. Severe complications of abortion
study. The standard data collection format was used as
specified in the data collection tool. If the subject was unable Other interventions that may be required include
to provide consent due to medical reasons, a waiver of interventional radiology, laparotomy (excluding caesarean
consent was obtained from the ethics committee and access section), and the use of blood products.
to medical records was requested.
2.6. Life-threatening conditions (near-miss criteria)
2.3. Ethical considerations
2.6.1. Cardiovascular dysfunction
Approval was obtained from the Institutional Ethics Shock, cardiac arrest (absence of pulse/heartbeat and
Committee before the beginning of study, confidentiality of loss of consciousness), use of continuous vasoactive
data was maintained throughout the study drugs, cardiopulmonary resuscitation, severe hypoperfusion
 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357 353

(lactate >5 mmol/l or >45 mg/dl), or severe acidosis were referred from a health facility, and 72 (63.86%) cases
(pH<7.1) – were multigravida. Based on the antepartum/postpartum
status of patients at the time of admission, most cases were
2.6.2. Respiratory dysfunction antepartum, accounting for 86 (75.44%) cases.
Acute cyanosis, gasping, severe tachypnoea (respiratory Table 2 shows that the diagnostic spectrum and organ
rate >40 breaths per minute), severe bradypnea (respiratory dysfunction in near-miss cases were mainly hypertension
rate<6 breaths per minute), intubation and ventilation not in pregnancy, accounting for 69 (60.53%) cases, followed
related to anaesthesia or severe hypoxemia (O2 saturation by hemorrhage in 62 (54.39%) cases andanaemia in 22
<90% for >60 min or PAO2/FiO2<200) (19.30%) cases. Covid-19 was also found in 24 cases,
representing 21.05% of cases with overlapping diagnoses.
2.6.3. Renal dysfunction In terms of organ dysfunction, respiratory dysfunction was
This refers to issues related to the kidneys. Symptoms may the most common, accounting for 28 (24.56%) cases, while
include oliguria, which is a decrease in urine output that is coagulation/haematological dysfunction and cardiovascular
not responsive to fluids or diuretics. In severe cases, dialysis dysfunction accounted for 26 (22.81%) and 24 (21.05%)
may be necessary for acute renal failure or acute azotemia, cases, respectively.
which is a build up of nitrogenous waste products in the Critical intervention as mentioned in Table 3 shows
blood (indicated by creatinine levels of ≥300 µmol/ml or that 97 (85.08%) cases were admitted to the ICU, and
≥3.5 mg/dl). 74 (64.91%) cases required the use of blood and blood
products, followed by IV antibiotics use in 72 (63.16%)
2.6.4. Coagulation/haematological dysfunction cases. Out of the 74 cases requiring blood products, 38
This refers to issues related to blood clotting and other blood (51.35%) cases required only PCV, while 28 (37.84%)
disorders. Symptoms may include failure to form clots, required PCV + FFP + Platelets transfusion.
which can result in massive transfusion of blood or red cells Table 4 shows that the maximum number of stays of
(≥5 units). Additionally, severe acute thrombocytopenia MNM cases in the ICU was 8 days, while in the hospital,
(platelet count < 50,000/ml) may also be present. it was 41 days.
Hepatic dysfunction with severe acute Various maternal near-miss indicators were shown in
hyperbilirubinemia (bilirubin>100 µmol/l or>6.0 mg/dl) Table 5. There were 9534 admissions for In-patient
and jaundice in the presence of pre-eclampsia. Department (IPD), 7296 deliveries and 6898 live births.
Neurological dysfunction including prolonged Out of these, there were 114 cases of maternal near-miss
unconsciousness (lasting ≥12 h)/coma (including metabolic and 16 maternal deaths. The severe maternal outcome ratio
coma), stroke, uncontrollable fits/status epilepticus, and (SMOR) was calculated as Severe maternal outcome (MNM
total paralysis. + MD) / 1000 live births (LB), and in our study, the SMOR
Uterine dysfunction, as well as hemorrhage or infection, was 18/1000 live births. The MNM ratio in our study was
can lead to the need for a hysterectomy. 16, and the MNM mortality ratio was 7.1 per 1 MD. The
Adopted from WHO (2011) mortality index in our study was 0.12 (12%).
Note that each critical intervention was counted
separately and some cases underwent multiple 4. Discussion
interventions. Therefore, the number of interventions
In the medical field, there are different ways to define
was greater than the number of cases.
maternal near-miss (MNM) cases. These include disease-
specific, organ dysfunction, and management criteria. Each
3. Results
approach has its strengths and weaknesses. 5–7 For our
During the study period, there were 9534 admissions for study, we followed the World Health Organization’s (WHO)
inpatient care, 7296 deliveries, and 6898 live births in our criteria which are similar to disease-specific criteria. 5 We
tertiary teaching institute. Among these, 130 cases of severe included MNM cases and evaluated their obstetric causes.
maternal outcomes were reported, including 114 cases of During our study period 9534 patients were admitted
maternal near-miss and 16 maternal deaths. with 7296 deliveries and 6898 livebirths. We recorded 130
Table 1 shows that 47 (41.23%) of the patients were severe maternal outcomes out of which 114 were MNM and
between the ages of 20-25 years, while 40 (35.09%) were 16 were maternal deaths. Among 114 maternal near miss
in the 26-30 years age group. The majority of the patients cases 6 cases were explored for ruptured ectopic pregnancy
were from rural areas, accounting for 66 (57.89%) of the & 10 cases were admitted with incomplete abortion. Out
cases. Patients withsocioeconomic status III were the most of 114 MNM cases, 4 cases were managed antenatally (2
common, accounting for 55 (48.25%) cases. Most of the cases for severe anemia with congestive cardiac failure and
nearly missed mothers were literate, with 102 (89.42%) 2 cases for COVID-19 pneumonia). During the study period,
having some level of education. 78 (68.42%) of the patients which coincided with the global COVID-19 pandemic, there
354 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357

Table 1: Demographic parameters

Demographic Parameters MNM cases Percentage
Age distribution of cases
<20 year 04 3.51
21-25year 47 41.23
26-30 year 40 35.09
31-35 year 17 14.91
36-40 year 04 3.51
41-45 year 02 1.75
Mean ± SD of age: 25.35 ± 05.19
Place distribution
Rural 66 57.89
Urban 48 42.11
Socioeconomic status (Modified BG Prasad Classification)
I 11 09.65
II 25 21.93
III 55 48.25
IV 20 17.54
V 03 02.6
Educational status of MNM
Illiterate 12 10.53
Education <8t h standard 45 39.47
Education >8t h standard 57 50.00
Admition methods
1. Direct admition 36 31.58
2. Referral 78 68.42
Referred from health facility 69 60.53
Referred from more than one health facility 09 7.89
Obstetric score of MNM
Primipara 42 36.84
Multipara 72 63.16

were 114 near-miss cases, out of which 24 cases had However, Dahie et al. reported most of cases were multipara
COVID-19 pneumonia. Unfortunately, the pandemic had a and 31.5% cases were referred from health facility. 10,11
significant impact on maternal mortality, with 16 maternal
deaths occurring during the study period. Out of these Our study found that hypertension in pregnancy was the
deaths, 9 were found to be COVID-19 positive. 8 major underlying cause in 69 cases (60.53%). Of these,
38 cases (33.33%) were severe pre-eclampsia, 18 cases
In our study 104(91.23%) MNM cases were found in the (15.79%) were eclampsia, and 13 cases (11.40%) were
age group of 20-35 years with 3.51% below 20 years of HELLP syndrome. Nakimuli et al. conducted prospective
age and 5.26% above 35 years of age. Out of 114 MNM cohort study of 695 maternal near miss cases in Uganda,
cases 66(57.89%) were from rural and 48 (42.11%) from study showed 32% hypertension in pregnancy, 19%
urban. According to BG Prasad classification 2019 Patients eclampsia, 11.4% severe pre-eclampsia, 1% HELLP, and
with socioeconomic status III are 55 (48.25%). Most MNM 0.6% chronic hypertension. 12,13 However, a study from
cases were literate 102 (89.47%) while 50% having studied Turkey by Süleyman Cemil Oğlak et al. reported that 56%
above 8th standard. Hospital based case control study from hypertension was the major underlying cause, which was
Western Ethopia Kumela L et al. studied 61 MNM cases similar to our study. 14,15 The next most frequent causes
and reported 73.77% MNM cases in the age group of 20- were hemorrhage in 62 cases (54.39%), anaemia in 22
34 years while 6.56% below 20 years and 19.67% above cases (19.30%), sepsis in 6 cases (5.26%), obstructed
35 years. Most of MNM cases were 72.13% from rural and labour in 4 cases (3.51%), heart disease in 1 case (0.88%),
27.87% from urban. 9 and others (including COVID-19) in 24 cases (21.05%).
Facility based case control study conducted in four Obstetric hemorrhage in 62 cases (54.39%) was the second
selected tertiary hospital in benadir region Somalia by Dahie underlying cause following hypertension in pregnancy in
et al. noted 72.5% MNM cases from urban and 71.9% cases our study. Of these, 16 cases of hemorrhage occurred in
were illiterate. 10 In our study 78(68.42%) MNM cases were early pregnancy due to ectopic pregnancies (6 cases) and
referred from health facility .72(63.86%) were multipara. abortions (10 cases), while 46 cases of hemorrhage occurred
 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357 355

Table 2: Diagnostic spectrum and organ dysfunction in MNM cases

Diagnostic Spectrum of MNM
Parameters MNM cases Percentage
Hemorrhage 62 54.39
1 Early pregnancy - -
1a. Ectopic pregnnacy 06 5.26
1b. Abortion 10 8.77
2 Llate pregnancy - -
[Link] placenta 09 7.89
2b. Placenta previa 12 10.53
2c. Postpartum haemorrhage 21 18.42
2d. Rupture uterus 04 3.51
Hypertension in pregnancy 69 60.53
A) Severe preeclampsia 38 33.33
B) Eclampsia 18 15.79
C) HELLP 13 11.40
Severe Anemia 22 19.30
Obstructed labor 04 3.51
Sepsis 06 5.26
Heart disease 01 0.88
Other (including COVID 19) 24 21.05
Organ dysfunction in MNM
Parameters (organ dysfunction) MNM cases Percentage
Cardiovascular 24 21.05
Respiratory 28 24.56
Renal 07 06.14
Hematological 26 22.81
Hepatic 08 07.02
Neurological 07 06.14
Utrine 06 05.26
Multiple organ dysfunction 03 02.63
Note: Each diagnosis and dysfunction is counted separately. In some cases, there are multiple diagnoses or dysfunctions involved, so the number of organ
dysfunctions and diagnoses is more than the total number of cases. To be noted – HELLP syndrome (Hemolysis Elevated liver enzymes Low platelet count)

Table 3: Critical interventions of maternal missed cases

Parameters Number of MNM cases Percentage
ICU Admission 97 85.08
Use of blood and blood products 74 64.91
Surgical intervention 69 60.52
1. B-Lynch Suture 08 7.02
2. B/L Uterine Artery Ligation 37 32.46
3. B/L Uterine Artery Ligation 14 12.28
4. Emergency obstetric Hysterectomy 04 3.51
5. Laprotomy (other than LSCS) 06 5.26
Broad spectrum Antibiotic 72 63.16
Use of Inotropic Drugs 22 19.30
- Mechanical Ventilation 26 22.81
Cardio Pulmonary Resuscitation 00 0.00
Dialysis for Acute Renal Failure 02 1.75
Blood transfusion status in near missed cases
PCV 38 51.35
PCV + FFP 08 10.81
PCV + FFP + PRP 28 37.84
Blood transfusion of near missed cases
Yes 74 64.91
No 40 35.09
356 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357

Table 4: Comparison of hospital and ICU stay of near missed cases

Stay in days Minimum Maximum Mean Standard deviation
ICU 01 08 03.46 01.46
Hospital 07 41 20.35 07.69
p-value t-statistic = 13.601, Degrees of freedom = 147, Two-tailed probability < 0.001, Written as: t (147) = 13.601,
p<0.001, Conclusion at the 0.05 critical alpha level: The difference is significant.

Table 5: Maternal near miss indicators

MNM Indicators Values
Total admissions 9534
Number of deliveries 7296
Live births 6898
Maternal near-miss cases 114
Maternal deaths 16
Severe Maternal Outcomes (SMO) 130
SMOR {(MNM+MD)/1000LB} 18 per 1000 live birth
MNMR (MNM/1000LB) 16 Per 1000 live birth
MNM-MR (MNM : 1MD) 7.1 Per 1 MD
MI(MD/{MNM+MD}) 0.12

in late pregnancy due to postpartum hemorrhage in 21 cases, deaths. In our study, 74 cases (64.91%) required blood
placenta previa in 12 cases, abruption placenta in 9 cases, and blood products transfusion. Among these cases, 38
and a ruptured uterus in 4 cases. (51.35%) needed only PCV, 28 (37.84%) required PCV +
However, a study conducted in Uganda, Nakimuli et al FFP + PRP transfusion, and 8 (10.81%) required PCV+FFP.
noted that 46.3% of obstetrics haemorrhage was the major 72 cases (63.16%) required broad-spectrum antibiotics, and
underlying cause of 11.8% of antepartum haemorrhage, 69 cases (60.52%) underwent surgical intervention, which
14.7% postpartumhemorrhage, 16.5% ruptured uterus, 3.3% included B lynch suture (8 cases), uterine artery ligation
of abortion-related haemorrhage, 12 A retrospective study (37 cases), internal iliac artery ligation (14 cases), obstetrics
of 125 cases of maternal near miss cases from Turkey by hysterectomy (4 cases), and laparotomy for ruptured ectopic
Süleyman Cemil Oğlak et al. reported 43.2% hemorrhage (6 cases). Out of 97 cases admitted in ICU, 26 cases (22.8%)
was the underlying cause following hypertension in required mechanical ventilation, 22 cases (19.3%) were on
pregnancy. 14 inotropic support, and 2 cases (1.75%) were on dialysis for
However, there was an overlap of diagnostic acute renal failure.
features/complications and organ dysfunction in However, in a study conducted by Nakimuli et al, it
many MNM cases, such as preeclampsia complicated was noted that 30.8% of cases received more than 4 units
by abruption. Our study found that respiratory of blood transfusion, 27.7% of cases required inotropic
dysfunction occurred in 28 cases (24.56%), followed support, 10% of cases were on dialysis for acute renal
by coagulation/haematological dysfunction in 26 cases failure, and 54.6% of cases were admitted in ICU. 12 A
(22.81%), and cardiovascular dysfunction in 24 cases study from Turkey conducted by Süleyman Cemil Oğlak et
(21.05%), with 7.02% of cases experiencing hepatic al reported that all 125 cases (100%) required admission
dysfunction and 6.14% experiencing renal dysfunction. to ICU. Of these cases, 1 (0.8%) was on ventilation, 2
During this study period, the COVID-19 pandemic had (1.6%) were on inotropic support, and 1 (0.8%) cases were
arrived, and as a result, respiratory dysfunction cases on dialysis for acute renal failure, 54(43.2%) cases were
were higher. A prospective descriptive study of MNM received blood transfusion. 14
cases by Chikadaya et al. included 2 tertiary public health In our study, SMOR was found to be 18 per 1000 live
hospitals from Zimbabwe reported 65.5% cardiovascular births, while MNMR was 16 per 1000 live births. The
dysfunction, 20.9% respiratory dysfunction, 10.9% MNMMR was 7.1 per 1 MD and the Mortality Index was
coagulation/haematological dysfunction, 3.6% renal 0.12 (12%). A study by Chikadaya et al. in Zimbabwe found
dysfunction, and 2.7% hepatic dysfunction. 16 SMOR to be 10.4 per 1000 deliveries, MNM ratio to be 9.3
In our study, 97 cases (85.08%) required admission to per 1000, MNM mortality ratio to be 8.5:1, and Mortality
the ICU. Among the near missed cases, the maximum ICU Index to be 10.6%. 16 Facility based cross-sectional study
stay was 8 days, while the longest hospital stay was 41 conducted in 6 public health hospitals by Jabir et al. in the
days. Proper and timely transfusion of blood and blood city of Baghdad, Iraq mentioned SMOR of 5.69 per 1000
products can help prevent a significant number of maternal live births, MNMR of 5.06 per 1000 live births, MNMMR
 Thakkarwad et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):351–357 357

of 9 per 1 MD, and Mortality Index of 11.03%. 17 9. Kumela L, Tilahun T, Kifle D. Determinants of maternal near miss in
Western Ethiopia. Ethiop J Health Sci. 2020;30(2):161–8.
10. Dahie HA. Determinants of maternal near miss events among women
5. Conclusion admitted to tertiary hospitals in Mogadishu, Somalia: a facility-based
case-control study. BMC Pregnancy Childbirth. 2022;22(1):658.
Our study concluded that hypertension in pregnancy and 11. Mantel GD, Buchmann E, Rees H, Pattinson RC. Severe acute
hemorrhage are major causes of MNM cases. An audit of maternal morbidity: a pilot study of a definition for a near-miss. Br
maternal near miss cases generates beneficial knowledge J Obstet Gynaecol. 1998;105(9):985–90.
12. Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Mbalinda SN,
regarding severe life-threatening conditions that can lead Nabirye RC, et al. Maternal near misses from two referral hospitals
to maternal mortality if left untreated. Intensive Care Units in Uganda: a prospective cohort study on incidence, determinants
(ICUs) and blood banks play a pivotal role in the prevention and prognostic factors. BMC Pregnancy Childbirth. 2016;16:24.
of maternal mortality. Timely referrals to teaching institutes doi:10.1186/s12884-016-0811-5.
13. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe
will help reduce maternal mortality. obstetric morbidity: case-control study. BMJ. 2001;322(7294):1089–
4.
6. Sources of Funding 14. Oğlak SC, Tunç Ş, Obut M, Şeker E, Behram M, Tahaoğlu AE.
Maternal near-miss patients and maternal mortality cases in a Turkish
None. tertiary referral hospital. Ginekol Pol. 2021;92(4):300–5.
15. Asalkar M, Thakkarwad S, Rumani I, Sharma N. Prevalence
of Maternal Mortality and Clinical Course of Maternal Deaths in
7. Conflict of Interest COVID-19 Pneumonia-A Cross-Sectional Study. J Obstet Gynaecol
India. 2022;72(3):208–17.
None. 16. Chikadaya H, Madziyire MG, Munjanja SP. Incidence of maternal
near miss in the public health sector of Harare, Zimbabwe: a
Acknowledgments prospective descriptive study. BMC Pregnancy Childbirth. 2018;18:1–
6. doi:10.1186/s12884-018-2092-7.
Our sincere gratitude goes to all supervisors, data collectors, 17. Jabir M, Abdul-Salam I, Suheil DM, Al-Hilli W, Abul-Hassan S, Al-
Zuheiri A, et al. Maternal near miss and quality of maternal health
ANMs, study participants with their family members for care in Baghdad, Iraq. BMC Pregnancy Childbirth. 2013;13:1–9.
their cooperation and support. We thank to Dean PGI- doi:10.1186/1471-2393-13-11.
YCMH for providing necessary support for carrying out
study.
Author biography
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