Role of acid-base imbalances and their management in near-miss mortality cases in obstetrics

Background: WHO (2008) defines Maternal Near-Miss mortality cases as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. This study was conducted to evaluate the prevalence and impact of acid-base imbalances in near-miss mortality in obstetrics patients. Material and Methods: A prospective cohort study was conducted from November 2015 to May 2017 at Department of Obstetrics and Gynaecology, GSVM Medical College, Kanpur. A total of 200 near-miss mortality cases were evaluated for acid-base imbalances and managed accordingly. It was further correlated with various outcomes during their hospital stay. Results: Out of 200 patients,78.5% severe anemia,46.5% hypertensive disorder,30.5% haemorrhage,7.5% sepsis,12.5% previous LSCS,5% obstructed labour. Acidosis was far more common than alkalosis with almost 2:1:1 ratio among Metabolic acidosis, Respiratory acidosis and Respiratory alkalosis. The presence of acid-base imbalance was significantly related to need of ICU care (p value <0.0001, odd’s ratio-3.31, 95% confidence interval = 2.31-4.73). The need of blood component transfusion was statistically significant (p value- 0.0082, odd’s ratio-1.45 and 95% confidence interval = 1.10-1.91). Conclusion: Prompt diagnosis and correction of acid-base imbalance along with ICU care and blood transfusion in near-miss mortality cases can reduce maternal mortality.