Severe obstetric morbidity and its outcome in patients presenting in a tertiary care hospital of Karachi.

Objective: To determine the frequency, types (disease states) and outcome of severe obstetric morbidity in patients presenting at a public-sector tertiary care hospital.

Methods: The cross-sectional study was conducted at the Obstetrics and Gynaecology Unit II, Civil Hospital, Karachi, from April to September 2010. Consecutive cases of severe obstetric morbidity (near-miss), as defined by specific criteria, presenting in emergency were included. They were categorised into six groups: haemorrhage, hypertensive disorders in pregnancy, sepsis, ruptured uterus, anaemia, and a miscellaneous group encompassing morbidities not falling in the aforementioned groups. Obstetric near-miss (ONM) cases were described by disease-specific criteria. Primary outcome measures were frequency of near-miss in each disease specific group, type (disease state) of near miss in a group, maternal outcome measures i.e. hospital stay >7 days, hysterectomy, urinary/faecal fistula, morbidity due to management intervention and maternal death. Maternal near-miss ratio and mortality to near-miss ratio were calculated. Secondary outcome measures were ventilator support for >24 hours, and intensive care admission for >48 hours.

Results: There were 1508 deliveries during the study period from which 130 patients met the inclusion criteria. Among the 130 enrolled patients, obstetric near-miss (survivors) were 111. Among the total of 1442 livebirths, the maternal near-miss ratio was calculated to be 76.97/1000 livebirths. Nineteen maternal deaths resulted in the near-miss to mortality ratio of 5.8:1. Haemorrhage (34.2%) was the most frequent group, followed by hypertensive disorders (29.1%) and ruptured uterus (11.53%). Case fatality rates of sepsis (35%) and miscellaneous (30%) groups were the highest. Hysterectomy rates were 3.60% and hospital stay > 7 days stood at 31.33%. The intensive care admission rate was 42.34%.

Conclusion: Haemorrhage, hypertensive disorders and ruptured uterus were the leading causes of obstetric near-miss, whereas sepsis, acute fatty liver of pregnancy and peripartum cardiomyopathy resulted in the highest case fatalities.