Four Years Maternal Missed Mortality Ratio and Mortality Index at A Tertiary  Care Hospital in Azad Kashmir

Objective: To calculate the Maternal Near Miss Mortality Ratio and Mortality Index at a tertiary care hospital in a developing country with limited healthcare resources. Study Design: Retrospective analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Shaikh Khalifa Bin Zayed Al Nahyan Hospital Azad Kashmir and Combined Military Hospital, Muzaffarabad Pakistan, from Jan 2015 to Dec 2018. Methodology: Four hundred and forty-nine severe maternal outcome cases admitted in Intensive Care Unit were included in our study. Maternal Near Miss Mortality Ratio and Mortality Index were calculated. SPSS version 23.00 used for statistical analysis. Results: The maternal near missed mortality ratio was 11:1, mortality index 8.68%, severe maternal outcome 1.58% with 39 maternal deaths. Most common causes of maternal morbidity were hemorrhage (56.1%); hypertensive disorders (24%); sepsis (3.5%) and cardiovascular diseases (1.8%). Hypertensive disorders of pregnancy (30.7%), hemorrhage (25.6%) and sepsis (25.6%) were the common causes of maternal deaths. The total ICU time in patient with near-miss was 1.9±1.7 days versus 2.6±3.14 days in deaths, p<0.001. Operative delivery was statistically significantly (p value <0.001) more common mode of delivery in severe maternal outcomes (66.6%) and maternal deaths (33.3%). Conclusion: Our study has shown 1.58% severe maternal outcomes amongst admitted pregnant, maternal near missed mortality ratio being 11:1, mortality index being 8.68%. Eclampsia, hemorrhage and sepsis are major cause of maternal death.