Prospective observational study of near-miss obstetric events at two tertiary hospitals in Mumbai, Maharashtra, India.

Objective: To review the incidence and patterns of near-miss obstetric events (defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy"), as well as studying the classification criteria for near-miss events.

Methods: A prospective observational study was conducted in two tertiary hospitals in Mumbai. Women with near-miss obstetric events were interviewed during the period September 2012-August 2013.

Results: There were 884 near-miss events among 877 women, with seven patients readmitted. Clinical-criteria for near-miss events, accounting for 701 (79.3%) cases, were the commonest among the three classifications of near-miss events. Among the cases observed, hypertensive disorders of pregnancy (472 [53.4%]), severe anemia (185 [20.9%]), and postpartum hemorrhage 68 [7.7%]) were the most common causes of near-miss events. The most common problem encountered by patients prior to hospital admission for the near-miss cases was the unavailability of treatment at lower-level health facilities, affecting 598 (68.2%) of the 877 study participants.

Conclusion: Hypertensive disorders of pregnancy, postpartum hemorrhage, and severe anemia remain important determinants in maternal morbidity. Facilities and training at first-referral units should be improved so that they can respond better to basic obstetric emergencies such as sepsis, hemorrhage, and shock.