A process of identifying cases with potentially life-threatening conditions in the hospital has been suggested and among these those with organ system failure or dysfunction as per the definition will be included as near miss cases. Recently, a WHO Expert Group has suggested a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases. This criteria also produces a large variation as it depends on the physical and human resources available and the criteria for admission to ICU used in the institution.( 14) The management based criteria mostly identifies emergency hysterectomy and intensive care unit (ICU) admissions as the major criteria. In another recent review on maternal near miss the authors observed that on using the disease specific criteria a higher percentage of near miss with a wider range of estimate is reported due to variation in the disorders being reported. The global maternal mortality ratio is 210/100,000 births while it is about 240 in developing countries as compared to 14/100,000 in developed countries.( 2, 3) India has also reported a decline with the figure for 2007-2009 being 212/100 000 births from 398 in 1997-1998 and 301 in 2001-2003.( 4, 5)Īlthough maternal mortality remains a significant public health problem, maternal deaths are rare in absolute numbers especially within a community, so that assessment of effects of care is difficult.( 6) To overcome this challenge, notion of severe acute maternal morbidity (SAMM) and near miss event was introduced in maternal health care to complement information obtained with review of maternal deaths.( 7) Improvement of maternal health is one of the millennium development goals, MDG 5 with Target 5 A that calls for the reduction of maternal mortality ratio by three quarters between 19.( 1) Since 1990, though maternal deaths world-wide have dropped by 47%, the number of maternal deaths in developing countries remains high. ![]() Maternal mortality is one of the important indicators used for the measurement of maternal health. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health. Certain maternal near miss indicators have been suggested to evaluate the quality of care. ![]() It is useful in identifying health system failures and assessment of quality of maternal health-care. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. ![]() To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. ![]()
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