Clinical profile and outcomes of severe acute maternal morbidities in a tertiary care centre, bangalore, india: a descriptive study

Background: Many complications can occur during pregnancy, delivery, and immediate postpartum that necessitate admission to the intensive care unit. As maternal mortality is declining in many areas of the developing world, its study alone may not be sufficient to provide information on the quality of care given. So, the emphasis is more on severe acute maternal morbidity (SAMM) or Maternal Near Miss (MNM) which has emerged as a promising alternative to maternal mortality reviews. This approach has an advantage over maternal mortality as it draws attention to the reproductive health of surviving women. Aim: To determine the clinical profile, predisposing clinical conditions, and outcomes of severe acute maternal morbidity. Methods: A descriptive study was conducted in Bangalore Baptist Hospital, Bangalore from November 2020 to June 2022. In this, data was collected about all the pregnant women and postpartum women up to 42 days of delivery who were admitted in the high-risk labour room, High Dependency Unit (HDU), and Intensive Care Unit (ICU). A total of 191 patients were enrolled and different variables were studied including demographic details, gestational age, comorbidities, Intensive care management, neonatal outcomes. Women with Life Threatening Conditions (WLTC), SAMM, and Maternal deaths (MD) were noted, and using these parameters, Severe Maternal Outcome Ratio (SMOR), Maternal Near Miss Incidence Ratio, and Mortality Index were calculated. Results: In 191 women with life-threatening conditions, 187 had SAMM and 4 patients succumbed to death. Most of the cases occurred in the maternal age group of 21-30 years. The majority of SAMM was due to obstetric haemorrhage that was seen in 73 patients (46.2%). This was followed by hypertensive disorders in pregnancy, which was seen in 65 patients (41.1%), and then sepsis, seen in 15 patients (15.24%). Most of them were managed by termination of pregnancy. Among them, 52.4% accounts for cesarean section. Severe Maternal Outcome Ratio was calculated to be 44.05 %. Maternal Near Miss Ratio was 43.13% and Maternal Near Miss Mortality Ratio was 46.75: 1. 20.94% mortality index was achieved in the study. Out of 155 births, 128 were live births, 14 were Intrauterine deaths, 10 fresh still births, 3 early neonatal deaths. Conclusion: Screening for high-risk pregnancies and timely detection of severe maternal morbidity is an important step toward promoting safe obstetric care. A multidisciplinary team with good ICU care and availability of blood and blood products will decrease maternal mortality.