Lakshmi

DISSERTATION ON
A PROSPECTIVE STUDY OF MATERNAL NEAR MISS AND

MATERNAL MORTALITY IN A TERTIARY CARE CENTER
WITH SPECIAL REFERENCE TO ITS ETIOLOGY AND
MANAGEMENT.
Dissertation submitted to
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY
In partial fulfillment of the regulations

for the award of the degree of
M.S. OBSTETRICS AND GYNAECOLOGY
BRANCH – VI
THANJAVUR MEDICAL COLLEGE,

THANJAVUR - 613 004
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI - 600 032
APRIL -2017
CERTIFICATE
This is to certify that this dissertation entitled “A PROSPECTIVE
STUDY OF MATERNAL NEAR MISS AND MATERNAL MORTALITY IN
A TERTIARY CARE CENTER WITH SPECIAL REFERENCE TO ITS
ETIOLOGY AND MANAGEMENT” is a bonafide original work of
Dr.LAKSHMI S. in partial fulfillment of the requirements for M.S Branch -
VI (Obstetrics & Gynaecology) Examination of the Tamilnadu Dr.M.G.R.
Medical University to be held in APRIL - 2017. The period of study was from
August 2015 to July - 2016.
Prof.Dr.M.VANITHAMANI, M.S., MCh.,, Prof. DR. S.PRADEEBA M.D., OG

THE DEAN, HEAD OF THE DEPARTMENT
THANJAVUR MEDICAL COLLEGE DEPT. OF OBSTETRICS AND GYNAECOLOGY
THANJAVUR - 613004 THANJAVUR MEDICAL COLLEGE
THANJAVUR - 613004
CERTIFICATE BY THE GUIDE
Certified that the thesis entitled “A PROSPECTIVE STUDY OF
MATERNAL NEAR MISS AND MATERNAL MORTALITY IN A
TERTIARY CARE CENTER WITH SPECIAL REFERENCE TO ITS
ETIOLOGY AND MANAGEMENT” has been carried out by
Dr.LAKSHMI S, under my direct supervision and guidance. All the
observations and conclusions have been made by the candidate herself and
have been checked by me periodically.
Place: Thanjavur Prof.Dr.R.RAJARAJESWARI.M.D,D.G.O.,DNB.,

Date : Professor and Unit Chief
Department Of Obstetrics And Gynaecology
Thanjavur Medical College
Thanjavur
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DECLARATION
I, Dr.LAKSHMI S., solemnly declare that dissertation titled “A
PROSPECTIVE STUDY OF MATERNAL NEAR MISS AND MATERNAL
MORTALITY IN A TERTIARY CARE CENTER WITH SPECIAL
REFERENCE TO ITS ETIOLOGY AND MANAGEMENT” is a bonafide
work done by me at Thanjavur Medical College, Thanjavur during
September 2015 to August 2016 under the guidance and supervision of
Prof.Dr.S.PRADEEBA, M.D.,OG., Head of the Department, Department of
Obstetrics and Gynaecology, Thanjavur Medical College, Thanjavur.
This dissertation is submitted to Tamilnadu Dr. M.G.R Medical
University towards partial fulfillment of requirement for the award of
M.S Degree (Branch -VI) in Obstetrics and Gynaecology.
Place: Thanjavur
Date: (Dr.LAKSHMI S)
ACKNOWLEDGEMENT
First and foremost I’d like to express my gratitude to the God Almighty
for everything.
I gratefully acknowledge and express my sincere thanks to
Prof.Dr,M.VANITHAMANI M.S., MCh Dean, Thanjavur Medical College and
hospital, Thanjavur for allowing me to do this dissertation and utilizing the
Institutional facilities.
I am extremely grateful to Prof Dr. S.PRADEEBA, M.D.,OG., Professor
and Head of the Department, Dept of Obstetrics and Gynaecology, Thanjavur
Medical College and hospital, for her full-fledged support and guidance.
I would like to express my gratitude to my guide
Prof. Dr.R.Rajarajeswari, M.D.,D.G.O.,D.N.B., for her full-fledged support,
valuable suggestions and guidance during my study and my post graduate period.
I would also like to thank Prof Dr.E.KALARANI, M.D.,D.G.O., formerly
Professor of the Department of Obstetrics and Gynaecology for her support and
guidance.
I would like to express my gratitude to my respected Professor
Dr.M.Poovathi M.D., D.G.O., for their guidance and constructive criticism in
completing my dissertation.
I would also like to extend my warmest gratitude to my coguide
Dr.Sudha.M.D, Assistant professor, Department of Obstetrics and Gynaecology
for her constant encouragement and support.

I express my sincere gratitude to all Assistant professors of our department
for their valuable guidance and suggestions that made this work possible.
I would also like to thank all the medical and para-medical staffs who have
helped me complete this study.
A special thanks to all the patients who willingly co-operated and
participated in this study.
I would like to thank all my colleagues and friends who have been a
constant source of encouragement to me.
I would like to express my most sincere gratitude to my family for their
constant support and tolerance.

CONTENTS
SL PAGE
TITLE
NO NO
1 INTRODUCTION 1
2 AIM OF STUDY 4
3. REVIEW OF LITERATURE 5
4. MATERIALS AND METHODS 46
5. RESULTS AND OBSERVATIONS 50
6. DISCUSSION 73
7. CONCLUSION 81
8. SUMMARY 82
9. BIBLIOGRAPHY
ANNEXURE
PROFORMA
MASTER CHART
INTRODUCTION
“Maternal mortality ratio is one of the health indicator used to
measure maternal health. Maternal death is tip of iceberg which has vast
base to the ice berg maternal morbidity which remains undescribed. To
challenge this problem, maternal near miss can be used as a
compliment to maternal death as a maternal health indicator”.
1
DEFINITION:
Maternal near miss is defined as “ pregnant or recently delivered
woman who survived a complication during pregnancy, childbirth or 42
days after termination of pregnancy”.
Practically “woman are considered near miss cases when they
survive life threatening conditions (ie,.organ dysfunctions)”
‘Maternal death’ is defined as “the death of a woman during
pregnancy or within 42 days after termination of pregnancy, irrespective of
the duration and site of the pregnancy, from any cause related to or
aggravated by pregnancy or its management but not from accidental or
incidental causes”.
2
CONCEPT OF NEAR MISS APPROACH
“ Near miss reviews offers informations about the delays in
seeking health care and other “health system failures” and allows
“assessment of quality of maternal health-care” so that appropriate action
can be taken. Using maternal Near miss indicators, the quality of
care can be evaluated. The “near miss approach” can be used as an
important device in the evaluation and assessment of the newer
strategies for improving maternal health”.
“Near miss cases possess similar characteristics like that of
maternal mortality and gives informations about various obstacles that had
to be overcome after the onset of an acute complication.For the last two
decades ,concept of maternal near miss approach has been gained
importance in maternal health.It is considered as an adjunct to maternal
death confidential inquiries”.
3
AIM AND OBJECTIVES
AIM:
To study the maternal near miss and mortality cases in a tertiary
care center with its special reference to its aetiology and management.
OBJECTIVES:
To study the
Age and parity distribution of the maternal near miss and mortality
cases.
Causes and incidence of maternal near miss morbidity and mortality.
Mode of intervention done to save the patients.
Pregnancy outcome in affected cases.
Calculating various maternal indices.
4
REVIEW OF LITERATURE
“According to the WHO systematic review of maternal morbidity and
mortality , Organ-system dysfunction/failure approach sounds good as
it has less bias”.( Say L et al 2009).
“Hemorrhage and hypertensive disorders are the leading causes of near
miss events. As near miss analysis indicates quality of health care, it is
worth presenting in national indices” (Roopa PS et al,2013)
“ Evaluation of the disease process earlier and earlier referral from
the primary health care level is of very important to maternal
morbidity and mortality”(HKD Sarma et al 2014)
“The most common cause of SAMM were sepsis., preeclampsia and
obstetric hemorrhage”.( Sousa et al,2010)
“ Hypertensive disorders and haemorrhage were the leading causes of
near-misses(86%). 60% 0f maternal mortality was due to hemorrhage
while sepsis had the higher mortality index (7.4%). Most of the cases
had near-miss upon during admission at the hospital. Almost one
5
fourth of near-miss cases needed ICU admission”. (Yara Almerie et
al’s review on 2006-2007)
“Hemorrhage, uterine rupture, puerperal sepsis, and complicated
abortions were the conditions leading to the near miss morbidity in
more than three fourth of the patients. In their study, more than half the
cases delayed to seek health care, because the patients were unwilling,
or relatives were not helpful. Other half also experienced substandard
health care in the hospitals”.( Okong P et al ,2005)
“The prevalence of SAMM cases ranged from 0.07 to 8.23% and the
case-fatality ratio from 0.02 to 37%. In their study severe
hemorrhage, sepsis and hypertensive disorders of pregnancy are the
common near-miss conditions.” (Minkauskiene M et al ,2004)
“The comprehensive emergency care and intensive care as well as
overall improvements in the quality of maternal health care need to be
achieved to reduce maternal death” (Norhayati MN et al I, 2014)
6
“One fifth of admissions in public hospitals were near miss cases and
the critical state of the women at arrival suggest delays in access to
the hospitals. Although the private sector largely share facility-based
births in Indonesia, managing obstetric emergencies remains the
domain of the public sector”.( Asri Adisasmita et al done at Indonasia
on 2014)
“A trial version for diagnosing ‘obstetric near-miss’ is proposed. It
includes the indicators ‘eclampsia’, ‘severe hypertension’, ‘pulmonary
edema’, ‘cardiac arrest’, ‘obstetrical hemorrhage’, ‘uterine rupture’,
‘admission to intensive care unit’, ‘emergent hysterectomy’, ‘blood
transfusion’, ‘anesthetic accidents’, ‘urea >15 mmol/l or creatinine
>400 mmol/l’, ‘oliguria (<400 ml/24 h)’ and ‘coma”( Michael E et al
on 2008 )
“The near miss approach allowed researchers and planners to develop
frameworks seeking to improve quality of maternal health care not
only at the facility level but also community health workers and
referral”.( Sanghita Bhattacharyya , 2014)
7
“The hospital-based MMR was 350 maternal deaths per 1lakh live
births . The MNMR was 23.6 per 1,000 live births, with an overall
case fatality rate of 12.9%.”(,Nelissen EJ et al ,2013)
“The near miss incidence was 12%. Severe obstetric
haemorrhage(41.3%), hypertensive disorders in pregnancy (37.3%),
Prolonged dystocia(23%), sepsis (18.6%) and severe anaemia(14.6%)
were the direct causes of near miss. The significant risk factors
were: chronic hypertension , emergency caesarian section , assisted
vaginal delivery. The protective factors included antenatal care
attendance at tertiary facility, knowledge of pregnancy
complications. Stillbirth was the most significant adverse perinatal
outcomes associated with near miss event”. ( Adeoye IA et al , 2013)
“Age of 35 or more years old women with past history of pregnancy
complications, underwent caesarean section deliveries, preterm
delivery and referral to tertiary centres were the associated factors for
SAMM cases”. (Norhayati MN et al)
8
“The MNMR of 32.9/1000 live births, a MMR of 54.8/1lakh live
births and a low mortality index of 1.7%. Hypertensive disorders
(52%) and haemorrhage (34%) were the leading causes of SAMM
cases. Late pregnancy haemorrhage was the leading cause of maternal
mortality (60%) while sepsis had the highest mortality index (7.4%).
Most cases were referred in critical conditions from other facilities
namely traditional birth attendants homes , primary and secondary
healthcare facilities and private practices . One fourth of near-miss
cases needed admission to Intensive Care Unit (ICU)”.(Yara almerie
al BMC Pregnancy and Childbirth201010:65)
9
10
MATERNAL MORTALITY
“ Millennium development goals were the eight international
development goals for the year 2015 which is established following
Millineum summit of the United Nations in 2000. Each goal has specific
targets.Of that goal 5 is to improve maternal health”.
Target 5A is to reduce MMR by three quarters between 1990 and 2015.
Target 5B is to achieve universal access to reproductive health.
11
MMR:
The Maternal Mortality Ratio (MMR) is defined as the “ratio of
the number of maternal deaths during a given time period per 100,000 live
births during the same time-period”.
The global maternal mortality ratio is 210/100,000 births
In developing countries - 240/100,000 births
In developed countries - 14/100,000
India (1997-1998) - 398/100,000 births
(2001-2003) - 301/100,000 births
(2007-2009) - 212/100 000 births
(2010-2012) -178/ 100 000 births
(2011-2013) -167/100 000 births
12
MATERNAL NEAR MISS:
“Near miss refers to a very ill pregnant or recently delivered woman
who nearly died but survived a complication during pregnancy, childbirth or
within 42 days of termination of pregnancy”.
“SAMM refers to a life-threatening disorder that can endup in near
miss with or without residual morbidity or mortality”.
13
IDENTIFICATION OF NEAR MISS CASES
Various criterias have been used to identify maternal near-miss
cases.Some of them are described as follows.
“Waterstone's Criteria
Severe preeclampsia
Eclampsia
HELLP syndrome
Severe hemorrhage
Severe sepsis
Uterine rupture”
( Waterstone M et al,2001.)
14
“Mantel's Criteria
Admission to the ICU for whatever reasons
Hypovolemia requiring 5 or more units of packed red blood cells
Pulmonary edema
Emergency hysterectomy for any reason
Admission to the ICU for sepsis
Intubation and ventilation for more than 60 minutes except for general
anesthesia
Diabetic ketoacidosis
Coma for more than 12 hours
Cardio-respiratory arrest
Peripheral O2 saturation <90% for more than 60 minutes
Ratio Pa O2/FiO2 < 300 mmHg
Oliguria, defined as urine output <400 ml/24 h, refractory to careful
hydration or to furosemide or dopamine
Acute urea deterioration to 15 mmol/l or creatinine >400 mmol/l
Jaundice with preeclampsia
Thyrotoxic crisis
Acute thrombocytopenia requiring transfusion of platelets
Sub-arachnoid or intra-parenchymatous hemorrhage
Anesthetic accident:
15
(1) severe hypotension associated with epidural or rachidian anesthesia –
hypotension defined as systolic pressure <90 mmHg for more than 60
minutes;
(2) failure in tracheal intubation requiring anesthetic reversion”
(Pattinson RC and Mantel G et al,2003)
“Pattinson et al. criteria
(1) haemorrhage leading to shock, emergency obstetrical hysterectomy,
coagulation defects and/or blood transfusion of 2 liters;
(2) hypertensive disorders in pregnancy includingeclampsia and severe pre-
eclampsia with clinical/ laboratory indications of termination of
pregnancy to save the woman’s life;
(3) dystocia leading to uterine rupture and impending rupture (prolonged
obstructed labour or previous caesarean section;
(4) infections causing hyperthermia or hypothermia or a clear source
of infection and clinical signs of septic shock;
(5) anemia with hemoglobin level < 6 g/dl or clinical signs of
severe anemia in a woman without severe haemorrhage.”
(Pattinson RC et al , 2003)
16
‘Three major criteria mentioned in a review conducted by the WHO, are
described in the following table’.
17
Organ system dysfunction based criteria along with laboratory based
criteria are feasible for identifying all SAMM cases and investigating its
causes.
More number of near miss cases can be reported without missing
using disease specific criteria.Management based criteria based on
emergency hysterectomy and ICU admissions depends on the physical and
human resources and criteria used for ICU admissions in the respective
institution.
“WHO CRITERIA 2009 FOR NEAR MISS CASES
SEVERE MATERNAL COMPLICATIONS
Severe postpartum hemorrhage
Severe preeclampsia
Eclampsia
Sepsis or severe systemic infections
Ruptured uterus
Severe complications of abortions
18
CRITICAL INTERVENTIONS OR INTENSIVE CARE UNIT USE:
Admission to intensive care unit
Interventional radiology
Laparotomy including hysterectomy excludes caesarean section
Use of blood products
LIFE THREATENING CONDITIONS(NEAR MISS CRITERIA)
Cardiovascular dysfunction:
Shock
Cardiac arrest
Use of continuous vasoactive drugs
Severe hypoperfusion(lactate>5mmol/L)
Severe acidosis(ph<7.1)
Respiratory dysfunction:
Acute cyanosis
Gasping
Severe tachypnea(RR>40/min)
Severe bradypnea(RR<6/min)
Intubation and ventilation not related to anaesthesia
Severe hypoxia(SPO2 <90%for >60 min or PAO2/FiO2<200)
19
Renal dysfunction:
Oliguria nonresponding to fluids or diuretics
Dialysis for acute renal failure
Severe acute azotemia(creatinine>3.5mg/dl)
Coagulation/hematological dysfunction:
Failure to form clots
Massive transfusion of blood or red cells(>=5units)
Severe acute thrombocytopenia(<50000platelets/ml)
Hepatic dysfunction:
Jaundice in presence of preeclampsia
Severe acute hyperbilirubinemia
(bilirubin>100µmol/L or >6mg/dl)
Neurological dysfunction:
Prolonged unconsciousness lasting >12hrs
Coma including metabolic coma
Stroke
Uncontrollable fits/status epilepticus
Total paralysis
20
Uterine dysfunction:
Uterine hemorrhage or infection leading to hysterectomy”
( Say L, Pattinson RC et al ,2004)
ADVANTAGES OF WHO Criteria 2009
Incorporates both Mantel’s and Waterston criteria
Minimises the chances of missing the cases.
21
OPERATION DEFINITIONS
Severe postpartum haemorrhage-
Vaginal bleeding after delivery (1000 ml or more) with
hypotension and need for blood transfusion.
Severe pre-eclampsia
22
Eclampsia- Generalized tonic clonic seizures in a patient without
previous history of epilepsy.
23
Severe systemic infection or sepsis-
Uterine rupture
24
Acute severe azotemia
Creatinine ≥300 µmol/l or ≥3.5 mg/dl.
• Cardiac Arrest
25
Cardiopulmonary resuscitation
DIC
1.Bedside clotting test
26
2.Laboratory tests
Acute thrombocytopenia(<50 000 platelets)
Low fibrinogen (<100 mg/dl)
Prolonged prothrombin time (>16s),
Elevated D-dimer (>1000 ng/dl)).
Gasping:
Terminal respiratory pattern.
Hysterectomy
Surgical removal of the uterus following infection or
haemorrhage.
27
Massive transfusion
Transfusion of ≥5 units of PRBC.
Conditions requiring massive transfusion are follows
Metabolic coma
Loss of consciousness with the presence of glucose and
ketoacids in urine.
28
Oliguria
Not responding to fluids or diuretics
Urinary output <30 ml/h for 4 hours
<400 ml/24hours
Prolonged unconsciousness
Loss of consciousness for > 12 hours
Severe acidosis: a blood pH <7.1.
Severe acute hyperbilirubinemia
Bilirubin >100 µmol/l or >6.0 mg/dl.
Severe acute thrombocytopenia
<50 000 platelets/ml.
Severe bradypnea:
Respiratory rate <six breaths/min
Severe hypoperfusion:
Lactate >5 mmol/l or 45 mg/dl.

29
Severe hypoxemia:
Oxygen saturation < 90% for ≥1 hour.
PaO2/FiO2<200.
Severe tachypnea
Respiratory rate >40 breaths/min
Shock:
Persistent systolic BP <80 mmHg
With a pulse rate >100bpm
Total paralysis
Status epilepticus.
Use of continuous vasoactive drugs
30
PREVALENCE OF NEAR MISS CASES
The prevalence of near miss depends upon the criteria used in the
study
Disease-specific criteria 0.80% and 8.23%
Organ-system based 0.38% - 1.09%
criteria.
Management-based 0.01% and 2.99%
criteria
In another, recent review on articles between January 2004 and
December 2010
Disease-specific criteria 0.6% and 14.98%
Organ-system based 0.14% and 0.92%
criteria.
Management-based 0.04% and 4.54%
criteria
31
C Purandhare et al ,Sep 2014 · BJOG show common causes of near miss
cases in the following picture
Causes of both near miss and mortality cases are similar
32
“Leading cause of maternal deaths in developing countries is
hemorrhage,while Anemia was reported as cause of death in 12.8% deaths
in developing countries and none in the developed countries.Anemia
contributes to maternal morbidity and mortality significantly in our country
also”.
DELAYS IN MATERNAL HEALTH CARE
Three delays in health care seeking have been noticed which
contributes to severe maternal life threatening complications and death.
33
First delay
‘ Delay in seeking health care by the woman and/or her family due
to lack of awareness
Failure to recognize danger signs or there is lack of support of the
family’.
Second delay
‘Delaying in reaching a health-care facility due to inaccessibility in
view of long distance, lack of transport’
Third delay
‘Failure to achieve proper care at the health facility due to wrong
diagnosis,clinical decision-making, lack of staffs and medicines’.
In developing countries, 75% of women with SAMM cases are
in a critical condition upon arrival, denoting the importance of the
first two delays.
34
.
MATERNAL NEAR MISS REVIEW
Quality of Care and Maternal Near Miss
“According to the WHS(World health statistics) 2011, the
deliveries by skilled birth attendant rose from 58% to 68% from 1990-2008”
35
Policy changes in India:
Promotion of institutional births
Delivery by skilled birth attendants and
Provision of Emergency Obstetric Care.
36
ADVANTAGES OF NEAR MISS APPROACH
To evaluate and strengthen the quality of health care in a
community
To identify health system failures
To identify the trends and pattern of SAMM cases.
To strengthen the referral system and the clinical interventions
available
‘MATERNAL NEAR MISS INDICES’
‘Live birth’
‘Severe maternal outcome/ Women with life-threatening conditions
Life-threatening condition =maternal deaths + maternal near-
miss cases.
WLTC = MNM + MD’
‘Severe maternal outcome ratio (SMOR)
Number of women with life-threatening conditions (MNM + MD)
per 1000 live births (LB). This denotes the amount of care and resource
needed in a health facility
SMOR = (MNM +MD)/LB’
37
‘MNM ratio (MNMR)
Number of maternal near-miss cases per 1000 live births
MNMR = MNM/LB’
‘Maternal near-miss mortality ratio (MNM : 1 MD)
Ratio between maternal nearmiss cases and maternal deaths.
Higher ratios indicate better care’.
‘Mortality index
Number of maternal deaths divided by the number of women with
life-threatening conditions
MI = MD/(MNM + MD
Higher index denotes low quality of health care’.
38
‘Maternal mortality ratio (MMR)
Number of maternal deaths in a given period divided by 100,000
live births during the same period’.
39
The above picture shows the comparison of MMR of indian states
with other countries.
40
EMERGENCY OBSTETRIC CARE (EmOC)
“BmOC-BASIC EMERGENCY OBSTETRIC CARE
Antibiotics
Oxytocics
Administer parenteral anticonvulsant for preeclampsia and eclampsia
Manual removal of retained products (MVA)
Perform aAssisted vaginal delivery”
“Comprehensive Emergency obstetetic
All 1-6 functions in the basic EmOC plus
Surgery(caesarean section)
Blood transfusion”
State of Tamil Nadu –achieves MMR-71/100000 live birth by improving
maternal outcome utilising EmOC services.
41
PREVENTION OF MATERNAL DEATH
42
Levels of health care
Primary health care provided at community level
Secondary health care provided at PHC,CHC,DH,etc,.
Tertiary health care provided at hospitals.
More number of complications occurs in cases in whom
delivery was conducted outside which indicates that there is still a lot to
improve the maternity services at the primary level .
43
The rural health care providers should create awareness in the community
and should work still more to improve primary level maternity care .
• Accredited social health activists(ASHA)
• Midwives
• Other health care providers
44
NEED FOR THE STUDY
Every year in India
Incidence of SAMM - 12/1000 births.
Thus SAMM cases continuous to have huge impact on the lives of
Indian women. Maternal death to near miss ratio and case fatality ratio are
the main indicators of SAMM. There is continued need to identify near miss
cases to assess the quality of health care. Analyzing near miss cases can
strengthen the understanding of the disease progression that ultimately kills
women and their by empower us to prevent maternal death.
45
METHODOLOGY
It is a prospective observational study conducted in the Department
of Obstetrics and Gynacology, Raja Mirasudhar Hospital, Thanjavur.
Patients who met the WHO inclusion near miss criteria during the
period August 2015 to july 2016 were included in the study.
Data input is done with a proforma prepared for the study.
46
WHO INCLUSION CRITERIA
Cases who met WHO near miss criteria- 2009
Maternal death during the study period was analysed.
Not restricted by gestational age.
Women who were brought dead (major delay in accessing care)
EXCLUSION CRITERIA
“Women those who develop such conditions unrelated to pregnancy
(not during pregnancy or 42 days after termination of pregnancy”.
47
CHARACTERISTICS INCLUDED IN THE STUDY
Age
Parity
Gestational age at admission
Booking status
Investigation for anemia,septicemia,eclampsia and for organ
dysfunction/failure.
Timing of maternal events
Interventions (surgery /ICU care) taken
Neonatal outcome
Mode of delivery
Underlying causes of maternal death
48
“The following near miss indices were calculated.
(1) MNM incidence ratio (MNM IR = MNM/LB).
(2) Maternal near miss mortality ratio( MNM: 1MD).
(3) Mortality index.
Evaluation of those factors related to near miss cases and maternal
death identifies the exact causes and its management in its early
stage and prevent death.
From the findings of our study, maternal death can be reduced by
following proper management protocols”
49
RESULTS AND OBSERVATIONS
“Number of deliveries in the study period- 14389 .
Number of live births-14257.
Number of near miss cases - 364
Number of maternal deaths – 29
Severe maternal outcome cases – 393”
50
AGE DISTRIBUTION
200
Near miss vs maternal death
12
180
160 10
140
8
120
100 6
80
60 4
40
2
20
0 0
<20yrs 20-25yrs 25-30yrs >30yrs
“In the near miss group,the commonly affected age group
were 20 to 25 years (39%).
In the mortality group, 37% cases were in age group of 20-25
years and 17% cases were more than 30 years of age.
Teen age pregnancy contributes 4% of severe maternal

outcome”
51
AGE DISTRIBUTION
Near miss Maternal death

Age
N=364 % N=29 %
<20yrs
14 3 3 1
20-25yrs
173 39 11 37
25-30yrs
119 32 10 34
>30yrs
58 15 5 17
52
BOOKING STATUS
300
250 25
20
200
15
150
10
100
5
50 0
0 BOOKED
UNBOOKED
BOOKED
UNBOOKED
“18% of near miss cases and 25% of the death cases were unbooked.
It indicates the importance of regular antenatal visits”.
Booking status Near miss Maternal death
N=364 % N=29 %
Booked 298 81 22 75
Unbooked 66 18 7 25
53
REFERRAL STATUS
190 25
185 20
180 15
175 10
170 5
165
0
“175 (49%) women in the near miss and 22 (76%) women in the
mortality group were referral cases.
Hence late referrals played an important role in the contribution of
life threatening maternal complications”
Referral status Near miss Maternal death
N=364 % N=29 %
Referred 175 49 22 76
Self 189 51 7 24
54
PARITY DISTRIBUTION
G1
G2
G3
G4
>G4
• “In the near miss group, 37% cases were primi and the rest were
multiparous.
• In the mortality group 48% were primi and the rest multiparous.
• Grand multiparity contributes 7% of life threatening maternal
complications”
55
PARITY DISTRIBUTION
PARITY NEAR MISS MATERNAL DEATH
N=364 % N=29 %
G1 136 37 14 48
G2 114 31 5 17
G3 66 18 4 15
G4 41 11 5 17
>G5 17 4 1 3
56
GESTATIONAL AGE
1st trimester
2nd trimester
3rd trimester
“In the near miss group, 203 cases (85%) were in the third
trimester and similarly in the mortality group, 74% of death occurs in the
third trimester which denotes that most of the pregnancy complications
occurs in the last trimester of pregnancy”.
57
GESTATIONAL AGE
NEAR MISS MATERNAL DEATH

GA in trimester
N=364 % N=29 %
1
40 10 6 20
2
21 5 2 6
3
203 85 21 74
58
MODE OF DELIVERY
SPONT.EXP
LN
EMER.LSCS
EMER.HYS
EMER.LAPAROTO
MY
MVA
“ Most of the nearmiss cases are delivered by emergency LSCS(56%)
and 16% of the cases required emergency laparotomy
In the mortality group most of them had labour natural.10% required
laparotomy”.
59
MODE OF DELIVERY
MODE OF DELIVERY NEAR MISS MATERNAL

DEATH
N=364 % N=29 %
SPON.EXPULSION 3 1 2 6
LABOUR NATURAL 68 19 14 48
EMER.LSCS 204 56 7 24
EMER.LAPAROTOMY 57 16 3 10
MVA 15 4 2 6
EMER.HYSTEROTOMY 17 4 1 3
60
NEONATAL OUTCOME

ALIVE
DEAD
“In the near miss group ,70% cases had live birth, 15% cases had still
birth and 15% cases had abortive outcome.In the mortality group,58% cases
had live birth and 42% cases had still birth”.
61
BIRTH WEIGHT
200 7
6
150 5
4
100 3
2
50
1
0 0
Most of the babies were of birth weight 1.5-2.5kg in the near miss group.
NICU ADMISSION
TOTAL
NICU
“31% and 48% of babies in near miss and mortality group
respectively required NICU admission”.
62
NEONATAL NEAR MISS MATERNAL
OUTCOME DEATH
N=312 % N=17 %
ALIVE 257 70 9 52
DEAD 55 15 8 48
MALE 153 49 8 48
FEMALE 159 51 9 52
BIRTH <1.5kg 61 19 6 35
WEIGHT
1.5-2.5kg 151 48 5 29
2.5-3kg 72 23 6 35
>3kg 28 8 0 0
NICU ADMISSIONS 99 31 8 48
63
TIME OF EVENT
AP
IP
PP
TYPE OF NEAR MISS MATERNAL DEATH

MATERNAL EVENT
N=364 % N=29 %
ANTEPARTUM 167 43 19 66
INTRAPARTUM 150 41 5 17
POSTPARTUM 47 12 5 17
“Most of the events occur in the antepartum(43%) and Intrapartum
(41%) period in the near miss group”.
64
0
20
40
60
80
100
120
140
HYPERTENSION
HEMORRHAGE
COAGULATORY
HEPATIC
CVS
NEAR MISS
RS
RENAL
SEPSIS
UTERINE
OTHERS
65
7
6
5
4
3
2
1
0
HYPERTENSION
HEMORRHAGE
COAGULATORY
HEPATIC
CVS
RS
MATERNAL DEATH
RENAL
SEPSIS
TYPE OF ORGAN DYSFUNCTION
CNS
“In our study, common cause of near miss events were
hypertensive disorders, haemorrhage and coagulatory dysfunction
responsible for 37% ,27% and 15% cases respectively”.
“Antepartum and postpartum hemorrhage contributes 21 % of near
miss events”.
“Cardiovascular dysfunction occurs in 8 cases(2%) ,hepatic
dysfunction in 8 cases (2%) and respiratory dysfunction in 6 cases(2%)
and uterine dysfunction leading to hysterectomy in 18 cases (4%)”.
Combination of two or more complications occurs in some
cases.Such common combinations were anemia with severe preeclampsia
and anemia with rheumatic heart disease ,etc,.
In the mortality group, cardiovascular disease and sepsis responsible
for 24% and 20% cases respectively.Severe anemia contributes 2% of near
miss and 6% of mortality cases .
66
DISEASE/TYPE OF NEAR MISS MATERNAL MORTALITY
DYSFUNCTION INDEX %
DEATH
N=364 % N=29 %
HYPERTENSION 125 34 0 - 1
HEMORRHAGE 99 27 3 10 2
COAGULATORY 58 15 2 6 3
HEPATIC 11 3 5 17 31
CVS 5 1 7 24 46
RS 6 2 3 10 33
RENAL 8 2 0 0 0
SEPSIS 8 2 6 20 42
UTERINE 18 4 0 - 0
ANEMIA
8 2 2 6 33
67
ICU STAY
400 30
350 25
300
250 20
200 15
150 10
100
50 5
0 0
TOTAL ICU TOTAL ICU
n=247 n=29
Most of the near miss(67%) cases required ICU admission.Almost
all cases in the mortality group need ICU care.
68
NEED FOR SURGICAL INTERVENTION
400 30
350 25
300
250 20
200 15
150 10
100
50 5
0 0
45 cases requires hysterectomy and rent closure was done for
5 cases in the nearmiss and hysterectomy in 4 cases in the mortality group.
69
NEED FOR BLOOD OR BLOOD
PRODUCTS
TOTAL
BLOOD
TRANSFUSION
64% near miss cases and 48% of cases in the mortality group requires
> 4 units PRBC and blood product transfusion to correct hemorrhagic and
non-hemorrhagic anemia.
70
MATERNAL DEATH
IN <24hrs
>24hrs
In our study , 27% of the cases died within a day of hospital admission.
71
“Maternal near miss indicators”
The following are the results of the indicators related to maternal health
derived from the study.
1. Total woman with life threatening complication (WLTC) was 393.
Maternal near miss (MNM) was 364cases
Maternal death (MD) was in 29 cases.
2. Total live birth (LB) was 14257.
3. Maternal near miss ratio (MNMR) was 25/1000 live birth.
4. Severe maternal outcome ratio (SMOR) is 27/1000 live birth.
5. Maternal near miss mortality ratio is 12.5:1
6. Mortality index was 7%.
7. Maternal mortality rate is 203/ 1, 00,000 live births”
72
DISCUSSION
“The quality of obstetric care can be analysed by evaluating maternal
mortality cases.The need to analyse the quality of maternal health care is
important for investments in the obstetric health care services”.
“The sequence from good health to death in a pregnant woman is a
clinical insult, followed by a systemic inflammatory response, organ
failure and finally death”( Pattinson et al,2003 )
The advantages of evaluating near miss cases over maternal death are
• Nearmiss cases are more in number than maternal mortality cases.
• By reviewing nearmiss cases ,useful informations about the factors
leading to maternal morbidity and mortality can be obtained.
• Identifying the prevalence of nearmiss and mortality cases in various
geographical areas of the world.
• One can learn from the nearmiss cases about the quality of care given
at the institution.
• And moreover maternal death are the tip of iceberg of the maternal
morbidity.
.
“Therefore study of maternal near-miss cases is now of growing importance
to determine the factors related to maternal death”.
73
“In our study, life threatening complications including death occurs
in 2% of all deliveries during the study period which denotes one out of
every 35 patients admitted in our hospital suffer from life threatening
complications”.
Our study 2% of all deliveries
Developing countries 4-8%
Developed countries 1%
“In our study, the near-miss to maternal mortality ratio was
12.5:1.This indicates that for every 12 women saved ,one died because of a
life threatening complications”.
MNM:MD in our study 12.5
In other Indian studies 5-10
European countries 117-223
Niger 11
74
“This ratio indicates the standard of obstetric care that our hospital
provides.
Mean age affected in our study was 22-25yrs. One study in Pakistan
showed that the mean age affected in both the group was 28 ± 5 yrs”
“ Our study found that 25% of maternal mortality cases were
unbooked.It indicates the significance of regular antenatal check ups.To
increase the booking status ,public awareness to be created at the
community level”.
Nearly 50% of near miss and 76% of mortality cases were referred
from nearby PHC and GH. Poor utilization of available health services
by the patient, traditional beliefs practices like preference of home delivery
from traditional birth attendants, poor transport facilities , late referrals
from primary health care centres where overenthusiastic attempts are made
to deliver vaginally in suboptimal condition are the reasons for late referral.
“Thus earlier referral of the complicated cases to tertiary care hospital is
very important to reduce the number of near miss and maternal mortality”.
“In our study, primi cases contributes more of the near-miss and
mortality events than the multiparous.
75
It may be due to
Lack of awareness about the pregnancy complications
severe preeclampsia and eclampsia is more prevalent in
the primi cases”.
“In our study most of the life threatening complications occur in the
third trimester of pregnancy which includes intrapartum period also.
Hence regular antenatal checkups from conception till delivery is very
important in the prevention, earlier diagnosis and treatment of obstetric
complications”
“Most of the patients with life threatening complications were
delivered by emergency caesarean section.This is similar to the studies
conducted by Adeoye IA et al and Norhayati MN et al”.
“Hypertensive disorder of pregnancy ( severe pre-eclampsia and
eclampsia ) is the most common cause (34%) of maternal morbidity in our
study.
Case fatality rate due to eclampsia is very low in our institution as we
are using MgSO4 in all cases”.
76
“Hemorrhage(PPH/ruptured ectopic/incomplete abortion) is the
second most common cause (27%) of maternal near – miss and mortality.
In our institution we are following proper protocol for the management of
hemorrhagic and non hemorrhagic anemia.Only 2% of deaths are due to
antepartum and postpartum hemorrhage.That too because of late referrals
from peripheries.Incidence of intramural death due to hemorrhage is very
low in our institution.
Almost all studies concluded that hypertensive disorder and
obstetrical hemorrhage are the common causes of near miss and mortality .
“Anemia and rheumatic heart disease leading to congestive cardiac
failure and pulmonary oedema were the most common causes (46%) of
maternal mortality in our study”.
“Organ system dysfunction was present in 78.8% of the near miss
cases and in all mortality cases. Hepatic ,cardiovascular,renal dysfunction
and uterine rupture were commonly involved in the study. This is
comparable to a study in Nigeria and another study done by Gandhi .
There was no mortality due to uterine rupture and all cases were
managed successfully in our institution. This implies that a good quality
treatment is secured to these patients in our hospital”.
77
The following table shows the comparability of maternal near miss
indicators with other studies,
HOSPITAL
STUDIES MNMR SMOR MNM:MD MI MMR
SETTING
Tertiary
Our study hospital, 25 27 12.5 7% 203
Thanjavur
FAAMCH,
HMD
Barpeta 42.1 52.7 3.9 20.4% 1085
Sarma et al
2015
Maysoon Teaching
hospital 5.06 69 9 11.03% -
Jabir et al Baghdad,
Iraq,2010
Ellen JT
23.6 27.1 6.75 12.9% -
Nielssen et al Bagdadh
iraq 2012
Western
Priyanka
rajasthan, 4.18 - 2.07 - 202
kalra et al
India, 2014
Tertiary
Roopa et al hospital, 17.8 - 5.6 14.9%
India,2012
Tertiary
Sangeetha
hospital, 3.98 5.17 5.4 22.8%
gupta
India,2015
78
Lack of skilled
personnel
• Early identification of
risk factors
Poor infrastructure • Good antenatal care
Poor antenatal care

• Timely delivery
Maternal death
• Mgso4 prophylaxis
Poor
Near miss events
tranport
facility
General pregnant • Good blood bank
population facility
Delayed
referrals
“More number of complications occurs in cases in whom
delivery was conducted outside which indicates that there is still a lot to
improve the maternity services at the primary level. The rural health
care providers should create awareness in the community and should work
still more to improve primary level maternity care” .
“In our study stillbirth is more in both groups (17 vs 48%)
indicates that it may be due to the complication itself or the foetus is
compromised in such obstetric emergency situation.
79
More number of deaths occur within a day of admission indicates
that majority of the cases were in a very critical stage during admission
itself 64% of near miss cases and 48% of mortality cases >4 units of PRBC
and blood products transfusion to correct hemorrhagic and non
hemorrhagic anemia.
Hence anemia is considered as an important cause and contributor to
maternal mortality and severe maternal morbidity”.
80
CONCLUSION:
“Our study shows that out of 393 women with life threatening
complications,though 29 cases died, there were another 364 cases who
were saved from the dreadful complication due to the effective management
provided in our setup which supports the view that near-miss cases provide
a larger sample to analyse the maternal health.
But the high incidence of near-miss to maternal mortality indicates
that a significant proportion of critically ill patient still die of these
complication.This may be due to more number of late referrals from nearby
PHC and GH.
Our study concludes that training of health care providers to fight
against the life threatening situations at primary level, early referral to
tertiary care hospital, following standard protocols in the management of
near miss cases is very crucial in the prevention of maternal death”.
81
SUMMARY
“The study was conducted in the department of obstetrics and
gynaecology,RajaMirasudhar Hospital, Thanjavur Medical
college,during August 2015 to July 2016.
Number of deliveries in the study in our institute were 14389.
Number of live births in the study period were 14257.
Mean age of patient in the nearmiss (39%) and mortality group
(37%) were 25 to 30years.
66 women(18%) in the near miss and 7 women (25%) in the
mortality group were unbooked.
175 (49%) women in the near miss and 22 (76%) women in the
mortality group were referral cases.
Most of the cases (37%) were primi in both groups.
Most of the nearmiss (55%)events occurs in the third trimester
and in the intrapartum period.
82
Most of the nearmiss cases(56%) were delivered by emergency
caesarean section. 48% 0f the mortality group were delivered by
labour natural.
31% of neonates in the nearmiss group and 48% of mortality group
requires NICU admission.
Hypertensive disorders(34%) and hemorrhage(27%) (complicated
abortions and PPH) were most common causes of nearmiss
mortality.Uncompensated cardiovascular diseases(24%) and sepsis(20%)
were the cuses of mortality.
Hysterectomy were done in 45 cases in the nearmiss group.
67% of near miss cases requires ICU admission .
64% of nearmiss and 58% of mortality group requires transfusion of
blood and blood products.”
83
“OTHER MATERNAL NEAR MISS INDICATORS
Maternal near miss ratio (MNMR) was 25/1000 live birth.
Severe maternal outcome ratio (SMOR) is 27/1000 live birth.
Maternal near miss mortality ratio is 12.5:1
Mortality index was 7%.
Maternal mortality rate is 203/ 1, 00,000 live births”
84
BIBLIOGRAPHY
1. World Health Organization. Evaluating the quality of care for severe
pregnancy complications -The WHO near- miss approach for maternal
health. Geneva:World Health Organization; 2011.
2. Shaheen F, Begum A. Maternal “Near Miss”.Journal of Rawalpindi
Medical College (JRMC).2014; 18(1): 130-132.
3. Say L, Pattinson RC, Gulmezoglu AM. WHO systematic review of
maternal morbidity and mortality: the prevalence of severe acute
maternal mortality (near-miss). Reprod Health. 2004; 1(3).
5. Mustafa R, Hashmi H. Near-miss obstetrical events and maternal death.
Journal of the college of physians and surgeons, Pakistan. 2009;
19 (12): 781-785.
6. Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ. “Near-miss”
obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective
study. Reprod Health. 2005; 2: 1186-95.

7. Pandey M, Mantel GD, Moodley J. Audit of severe acute morbidity in
hypertensive pregnancies in a developing country. J Obstet Gynaecol.
2004; 24: 387-91.
8. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe
obstetrics morbidity: case-control study. BMJ. 2001; 322: 1089-93.
9. Minkauskiene M, Nadisauskiene R, Padaiger Z, Makari S. Systemic
review on the incidence and prevalence of severe maternal morbidity.
Medicina(Kuanas). 2004; 40: 299-309.
10. Prual A, Huguet D, Gabin O, Rabe G. Severe obstetric morbidity of the
third trimester, delivery and early perpeurium in Niamey (Niger). Afr J
ReprodHeath. 1998; 2: 10-9.
11. Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality
in obstetrics. Br J Obstet Gynaecol. 1998; 105: 981-4.
12. Kaye D, Mirembe F, Aziga F, Namulema B.Maternal mortality and
associated near-misses among emergency intrapartum obstetric referrals
in Mulago Hospital, Kampala, Uganda. East Afr Med J. 2003; 80:144-9.

13. Fillipi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, et al. Maternity
wards or emergencyobstetric rooms? Incidence of near- miss events in
African Hospitals. Acta Obstet Gynaecol Scand. 2005; 84: 11-6.
14. Baskett TF, Sternadel J. Maternal intensive care and near-miss mortality
in obstetrics. Br J Obstet Gynaecol. 1998; 105: 981-4.
15. Pattinson RC, Buchmann E, Mantel G, Schoon M,Rees H. Can
enquiries into severe acute maternal morbidity act as a surrogate
maternal death enquiries?Br J Obstet Gynaecol. 2003; 110: 889-93.
16. Gandhi MN, Welz T, Ronsmans C. Severe acute maternal morbidity in
rural South Africa. Int J Gynecol Obstet. 2004; 87: 180-7. and quality of
emergency obstetric care in Gambia's main referral hospital: Women-
users’ testimonies. Reprod Health. 2009;6:5.

ANNEXURE
PROFORMA
Name of the patient
Age
Occupation
Address
Socioeconomic class
IP NO.:
DOA:
DOD:
Booked/unbooked
Referral status:
Presenting complaints:
Menstrual history:
Marital history:
Obstetric history:
Obstetric score
Detailed history of previous pregnancy
Past history:
Family history:
Personal history:
General examination:
BP: PR:
RR: SPO2:
Per abdomen:
Per vaginal examination
INVESTIGATION
Complete hemogram
urine-
albumin
sugar
deposits
Blood group
BT:
CT:
Platelet count:
RBS:
Blood urea:
Creatinine:
Sr.Electrolyte
ECG:
LFT:
PT:
INR:
ECHO:
ABG:
Sr.lactate
Transabdominal USG
Transvaginal USG
Timing of near miss events and maternal mortality
DATE AND TIME OF DELIVERY
NEONATAL OUTCOME
Live/stillbirth/macerated
Term/preterm
Sex:
Wt:
APGAR
NICU admission
TYPE OF MATERNAL EVENT
DYSFUNCTION CAUSED-
cardiovascular/respiratory/renal/coagulation/hepatic/neurological/uterine
CRITICAL INTERVENTION
ICU intervention
Duration of ICU stay
Laparotomy
Use of blood products
MATERNAL MORTALITY
Cause:
Time of death:
Admission to delivery interval:
Delivery to death interval:
Admission to death interval:

Month: January
Referral OBS Mode of Time of Alive/
S.No Name Age IP No B GA DOA Vitals / Inv
Status Score Delivery Delivery Dead
distension
G2P1L1 PR-120/min Em.Lapar
1 Muthulakshmi 35 399855 No -- 1 5/1/16 -- --
NVP+ Na-130 otomy
k+-4mg
2 Rajeshwari 22 400517 Yes -- G2P1L0 3 11/1/16 Em.Lscs -- D
PR-136/Min
RR-38,temp- 100F
Lscs
3 Roobini 26 405760 Yes Referred P2L2 3 20/01/16 Hb-5.2g 18/01/16 A
plt-26000 outside
u66 ,c24
pallor ++
4 Priya 28 405965 No -- PRIMI 3 21/01/16 -- 21/01/16 --
Hb-4g
pallor ++
5 Ruby 24 404451 Yes Referred G3P2L2 3 8/1/2016 59000 LN 8/1/2016 A
Hb-5.4g
BP-200/110
6 Bhavani 28 405201 Yes -- PRIMI 3 12/1/2016 Blurring of Em.Lscs 12/1/2016 A
vision
7 Sutha 24 404997 Yes Referred PRIMI 3 13/01/16 BP-200/110 Em.Lscs 13/01/16 A
BP-80/50
8 Vidhya 25 405662 Yes Referred G2P1L1 3 20/01/16 Em.Lscs 20/01/16 D
133/Min
Em.hyste
rotomy
9 Keerthiga 25 405436 Yes -- G2P1L1 2 20/01/16 Bleeding PV 20/01/16 A
proceede
d to TAH
Bb-26
10 Deivamani 28 405602 Yes -- G2A1 3 20/01/16 PT-2.8 LN 24/01/16 A
INR
Jaundice
11 JeslinKavya 23 405268 Yes Referred Primi 3 16/01/16 Em.Lscs 17/01/16 A
97000
RR-28/min
G3P2L2
12 Jayanthi 28 401817 No Referred 3 21/12/16 SPO2-94% Em.Lscs 02/01/16 A
Breech
Hb-3.9g
Ascidia
13 Sandhya 21 403644 Yes Referred Primi 3 02/01/16 BP-140/110 Em.Lscs 02/01/16 A
Hb-7.7
pallor+++
14 Tamilselvi 27 405430 Yes Referred Primi 3 18/01/16 LN Epi 18/01/16 A
Hb-4.7
BP-180/100
15 Sutha 23 404974 Yes -- Primi 3 13/01/16 Em.Lscs 14/01/16 A
132/min
Confused
Hb-6.7
Primi Em.Lscs
16 Umadevi 37 405208 Yes Referred 3 16/01/16 plat 18/01/16 A
NVP+ve
67000
HELLP
28000
PR-119
BP-70/50 Em.Lap
17 Vidhya 25 405662 Yes Referred G2P1L1 3 20/01/16 20/01/16 D
92% TAH
38/min
Em.Rpt
G2L1P1 140/min
18 Karthiga 25 405436 Yes -- 2 20/01/16 Lscs 20/01/16 A
6MA
TAH
Bp-140/100
Lscs
19 Priya 23 405631 Yes Referred Primi 3 23/01/16 plt – 53000 -- --
ARF
outside
20 Meena 22 405992 Yes Referred Primi 3 23/01/16 Hb -4.2g -- -- --
Hb-26
21 Deivamani 25 405999 Yes Referred G2A1 3 23/01/16 LN epi 25/01/16 A
17+8
pallor+ MVA
22 Kamalam 25 405011 No Referred G4P3L3 1 27/01/16 25/01/16 --
Hb-3.6g done
23 Ranjitha 24 405116 Yes Referred Primi 3 28/01/16 Bp-200/120 Em.Lscs 28/01/16 A
Shock
24 Kalavathi 24 401800 No -- G3P2L2 1 03/01/16 MVA 03/01/16 --
Hb – 4.3g
25 Ramya 20 402766 No -- Primi 1 06/01/16 Hb-5.2g MVA 06/01/16 --
Severe anemi
26 Revathy 26 405978 No Referred G4P3L3 3 22/01/16 LN 25/01/16 A
Hb – 3.6g
LN
27 Chitra 34 404398 Yes Referred G6P5L4 3 19/01/16 Hb – 4.1g 19/01/16 A
Outside
28 Rubini 20 404012 Yes Referred Primi 3 15/01/16 Bp – 200/100 LN 15/01/16 A
29 Selvi 26 404498 No Referred Primi 3 20/01/16 Bp – 220/120 LN 20/01/16 A

Month:January
Timing Type of
S. Surgical
Sex Weight NICU of Type of Event dysfunction ICU Blood
No intervention
Event caused
MVA Uterine perforation
Laparotomy
Anterior wall rectal 4U pc
1 -- -- - - uterine Yes proceeded to
perforation infiltaration by 2U ffp
TAH done
malignancy
3U pc
Abruption Grade
2 F 2.4Kg IP coagulatory Yes - 8U ffp
III/Polyhydramnios – 35cm
6U plt
1U pc
3 F 3.07Kg - PP AKI/DIC/MODS/hemodialysis coagulatory Yes - 4U plt
6U ffp
4U pc
Ruptured ectopic with 2litres
4 -- -- -- Hrg Yes - 4U plt
hemoperitoneum+500g of clot
3U ffp
3U ffp
Fever/Thrombocytopenia with
5 M 1.9Kg + IP coagulatory Yes - 3U pc
hypertension/HELLP
9U plt
Impending DIVC/Severe
6U ffp
6 M 1.8Kg + IP preeclampsia/ postpartum coagulatory Yes -
2U pc
blurring of vision
F 1.8Kg severe preeclampsia with Yes
7 + PP HT - 1U pc
M 2Kg pulmonary edema CPAP
5U pc
8 D 3.4Kg - IP Rupture uterus with shock Hrg Yes TAH 6U plt
6U ffp
5U pc
placenta accreta with bleeding
9 F 600g - IP uterine Yes TAH 6U plt
per vaginum
6U ffp
12U ffp
10 F 2.5Kg + AP Acute liver failure,Jaundice coagulatory Yes - 8U plt
1U pc
11 F 2.6Kg - AP severe preeclampsia/HELLP coagulatory Yes - -
6U pc
12 F 1.9Kg + AP Mild MR/Severe anemia/CCF CVS Yes -
4U ffp
severe preeclampsia with 4U pc
13 F 1.6Kg + IP HT Yes -
uncontrol HT 170/130 4U ffp
Severe Anemia/Congestive 5U pc
14 M 2.2Kg - AP CVS Yes -
Cardiac failure(CCF) 4U ffp
F 2.5Kg
15 - PP Pulmonary edema CVS Yes - --
F 2.1Kg
Hepatic encephalopathy 6U ffp
16 F 1.3Kg + AP coagulatory Yes -
MODS 1U pc
D/F 6U ffp
17 3.4Kg - AP Rupture ectopic with shock uterine Yes +
1U ffp
6U pc
18 F 600g - IP placenta accreta uterine Yes - 6U ffp
6U plat
postpartum eclampsia/mild 12U plt
19 -- - PP coagulatory Yes -
ARF/Thrombocytopenia 2U pc
2U pc
Jaundice/hyperemesis
20 -- - AP hepatic Yes - 16U ffp
gravidorum
12U plt
21 F 1.8Kg + AP Jaundice complicating hepatic Yes - 5U pc
Incomplete Abortion/severe
22 -- - - -- hrg Yes - 5Upc
anemia/ shock
23 M 2Kg - AP Antepartum eclampsia HT Yes - 5U pc
Hypovolemic shock/severe
24 -- -- -- hrg Yes + 4U pc
anemia /Incomplete abortion
Hypovolemic shock/severe
25 -- -- -- hrg Yes - 4Upc
anemia/Incomplete abortion
26 F 3 Kg - AP Severe anemia with CCF other Yes - 5Upc
Postpartum Eclampsia with other
27 M 2.8 Kg - AP Yes - 5Upc
severe anemia HT
28 M 3.2 Kg - IP IP Eclampsia HT Yes - 2Upc
29 M 3 Kg - AP Severe preeclamsia HT Yes - -

Month: February

Bp-110/90
01 Philomina 33 403340 Yes Referred G3P2L2 3 10/02/16
pollor+++
Lscs Hys 28/02/16 D
Em.Lscs
02 Uma 30 408579 Yes -- G5P4L4 3 13/02/16 Bp-200/110 22/02/16 D
with Blynch
dysprocii/tachy
PR-126/min Em.Rpt Lscs
03 Poornam 28 409180 Yes Referred G2P1L1 3 17/02/16
RR-38/min
19/02/16 A
B/L St
SPO2-92%
Senthamil
04 25 409230 Yes -- Primi 3 18/02/16 Bleeding p/v LN epi 28/02/16 A
selvi
Bleeding p/v Em.Lscs

05 Rajalakshmi 24 408950 Yes -- Primi 3 16/02/16 16/02/16 A
Bp-160/100 B/L ut Lig
06 Suganya 22 409889 Yes Referred Primi 3 24/02/16 Bleeding p/v Em.Lscs 24/02/16 A
Primi
07 Chitrakala 31 408345 Yes -- 3 10/02/16 Bp-160/100 Em.Lscs 11/02/16 A
35wks
08 Sudha 20 408143 Yes Referred Primi 3 12/02/16 Bp-180/130 Em.Lscs 12/02/16 A
Primi
09 Yazhini 26 408494 Yes -- 3 11/02/16 Bp-180/120 Em.Lscs 13/02/16 A
36wks
G2P1L1
10 Meenambal 33 408878 Yes Referred 3 15/02/16 Bp-180/110 Em.Lscs 16/02/16 A
31wks
Primi
11 Sangeetha 26 408789 Yes -- 3 15/02/16 Bp-170/130 Em.Lscs 15/02/16 A
34wks
Primi
12 Mariya 24 410139 Yes Referred 3 25/02/16 Bp-180/120 Em.Lscs 26/02/16 A
32wks
pallor+++
13 Salai 25 406889 Yes -- G3P2L2 3 02/02/16 Bp-70/50 MVA done 02/02/16 --
RR-126/min
14 Kanmani 20 407921 Yes Referred Primi 3 04/02/16 BP – 160/100 Em.Lscs 04/02/16 A
15 Rajamani 23 407996 Yes -- G3P2L1 3 06/02/16 BP-180/120 LN.epi 06/02/16 A
BP – 70/50
16 Kalpana 25 408112 Yes -- Primi 3 08/02/16 PR-130 Hb – LN.epi 08/02/16 A
5g
17 Ramya 22 408608 Yes Referred G2P1L1 3 19/02/16 Bp – 6mg LN 16/02/16 A
18 Selvarani 24 408988 Yes Referred G3P2L1 3 18/02/16 TAH 25/02/16 A
Hb – 7.3g
Urea – 97g Spontaneous
19 Priya 22 408666 Yes Referred G3A2 2 15/02/16 16/02/16 D
creatinine – expulsion
2.4g
Month:February
Timing Type of
S. Surgical
No intervention
Event caused
Abruption Grade III
8 U pc
Atonic PPH/ scar rupture Post CPR
1 M 2.7Kg - AP coagulatory TAH 10 U ffp
CPR/AFI/Pulmonary edema with CPAP
8 U plt
global hypokinesia
4U pc
2 M 1.7Kg - AP Abruption grade III coagulatory Yes - 6 U ffp
6 U plt
ATT
3 M 2.6Kg - AP Pleuropericardial effusion CVS - --
Cat I
10 U pc
Abruption Grade III
4 M 2Kg - AP coagulatory Yes - 10 U plt
Vaginal hematoma/DIC
10 U ffp
6U ffp
Abruption Grade III/
5 M 1.6Kg + AP coagulatory Yes 3U pc
Impending DIC
4U plt
Abruption Grade III / Intrauterine 7U ffp
6 F 1.8Kg + AP Death / DIC coagulatory Yes - 5U pc
3U plt
M 2.1Kg Imminent eclampsia with mild atonic

7 - AP HT -- - -
M 2.3Kg PPH
8 F 2.7Kg - AP Antepartum eclampsia HT -- - -
9 F 22Kg - AP Imminent eclampsia HT -- - -
10 F 1.9Kg + AP Imminent eclampsia HT -- - -

11 M 1.7Kg + AP Imminent eclampsia HT -- - -
1U pc
12 F 1.1Kg + AP Impending DIC/Severe Preeclampsia coagulatory -- -
6U ffp
Incomplete Abortion
13 -- -- -- Hrg -- - 5U pc
Hypovolemic shock
Severe eclampsia
14 F 1.9Kg + AP HT CPAP - --
Acute pulmonary edema
15 M 2.2Kg - AP Imminent eclampsia HT -- - --
10U ffp
16 F 2.5Kg - PP Atonic postpartum haemorrhage hrg Yes - 5U pc
6 U plt
2U pc
17 M 2.75 Kg + AP ?AFLP Hepatie Yes -
10 U ffp
5U pc
18 F 2.2 Kg - IP Central placenta previa with bleeding hrg Yes TAH 16 U ffp
10 U plt
2U pc
19 F 1.2 Kg - AP GHI / HELLP / AKI Renal Yes - 10 U ffp
6 U plt
Month: March
S.No Name Age IP No B Referral OBS GA DOA Vitals / Mode of Time of Alive/
Status Score Inv Delivery Delivery Dead
01 Pavithra 24 411359 No Referred G3P1L1A1 1 05/03/16 80/50 MVA -- --
3 Em.Lscs A
Bp – impending DIC
02 Renuka 23 410636 Yes Referred Primi 29/03/16 200/120 severe pre-ecl 01/03/16
3 Bp – Em.Lscs A
03 Vijaya 28 410939 Yes Referred G2P1L0 02/03/16 160/110 02/03/16
3 Bp – Em.Lscs with D
04 Sangeetha 28 410962 Yes -- Primi 03/03/16 170/120 B/L ut A.lig 03/03/16
3 Bp – Em.Lscs A
05 Deivanai 22 410954 Yes Referred Primi 03/03/16 200/130 03/03/16
3 Em.Rpt. A
06 Sivagamy 28 411131 Yes -- G2P1L2 04/03/16 -- Lscs 04/03/16
3 Bp – Em.Lscs A
07 Anandhi 23 411527 Yes -- Primi 07/03/16 180/110 07/03/16
3 Bp – Em.Lscs A
08 Krishnaveny 24 411627 Yes Referred Primi 08/03/16 200/120 08/03/16
3 Assisted D
Bp – Breech
09 Vetriselvi 24 411845 Yes -- G2P1L1 09/03/16 180/110 Delivery 09/03/16
10 Ramzan Kani 26 412168 Yes Referred Primi 3 11/03/16 Em.Lscs 12/03/16 A
Bp –
180/120
Em.Lscs
U/A++++ done outside
Bp – Abdominal
11 Sudha 28 412123 Yes Referred P1L1 3 11/03/16 160/110 Preg 21/03/16 A
3 Em.Lscs A
12 Anushya 23 412294 Yes Referred P1L1 13/03/16 SPO2-92% done outside 12/03/16
3 Em.Lscs D
13 Seethalakshmi 24 412320 Yes Referred G2P1L1 13/03/16 Hb-5g 13/03/16
3 Em.Lscs A
14 Banu 24 411859 Yes -- Primi 09/03/16 -- 14/03/16
Muthamil 3 Rent closure D
15 Selvi 27 412610 Yes -- Primi 14/03/16 Hb-5g 15/03/16
16 Sathya 22 412993 Yes -- Primi 2 17/03/16 Bp-180/120 Em.Hysterotomy 17/03/16 D
2 Em. D
17 Rani 24 411597 Yes Referred G2P1L1 17/03/16 Bp-200/120 Hysterotomy 18/03/16
18 Parameswari 23 413520 Yes -- G3P2L2 3 20/03/16 - Rent Closure 20/03/16 A
19 Latha 36 413369 Yes Referred G3P2L2 3 20/03/16 Bp-160/120 Em.Lscs 21/03/16 A
20 Chitra 28 413793 Yes -- G3P2L2 3 23/03/16 Bp-180/110 Em.Lscs 23/03/16 D
21 Maheswari 24 413797 Yes Referred Primi 3 23/03/16 Bp-200/120 Em.Lscs 23/03/16 A
22 Sinthamani 20 413921 Yes -- Primi 3 23/03/16 Bp-180/110 Em.Lscs 24/03/16 A
23 Radhika 25 414022 Yes -- Primi 3 24/03/16 Bp-200/120 Em.Lscs 24/03/16 D
24 Rajeswari 26 414209 Yes -- G3P2L2 3 26/03/16 Bp-180/110 Em.Lscs 26/03/16 D
25 Rajamani 24 411598 No Referred Primi 3 17/03/16 Bp-160/120 LN 18/03/16 A
26 Ramani 19 413790 Yes Referred G2A1 3 23/03/16 Bp-170/110 LN 23/03/16 A
27 Bavani 22 412998 Yes Referred G2P1L0 3 18/03/16 Bp-160/110 LN 18/03/16 A
28 Shankari 21 412192 Yes Referred Primi 3 12/03/16 Bp-160/120 LN 13/03/16 A
29 Saranya 24 410610 Yes Referred Primi 3 02/03/16 Bp-170/110 LN 02/03/16 A
Month:March
Timing Type of
S. Surgical
No intervention
Event caused
Septic 3 U pc
1 -- -- - -- sepsis CPAP --
Abortion 4 U ffp
2 U pc
2 F 2Kg - IP DIC/severe preeclampsia coagulatory Yes --
4 U ffp
Imminent eclampsia Uncontrolled
3 M 0.8Kg - AP HT CPAP --
Hypertension
2 U pc
4 F 1.3 Kg - IP Abruption Gr-3 coagulatory Yes --
6 U ffp
5 M 2.4 Kg - AP Antepartum eclampsia HT Yes -- 1 U pc
Rent closure 3 U pc
6 F 2.5 Kg - IP Rupture uterus Uterine Yes
done 2 U ffp
7 F 2.4 Kg - AP Antepartum eclampsia HT Yes --

--
Impending DIVC/uncontrolled 1 U wb
8 M 2Kg - PP coagulatory Yes
Hypertension -- 6 U ffp
9 M 1.2 Kg - IP Abruption Grade IIIa coagulatory Yes -- 6 U ffp
10 F 2.1 Kg - -- Abruption Grade IIIa coagulatory Yes -- 6 U ffp
Yes
Antepartum eclampsia
11 F 1.16 Kg - AP HT ET+ -- 4 U pc
Extrauterine pregnancy
MV
M
PP PPH CPAP --
12 2 Kg hrg 4 U pc
Acute pulmonary edema
4 U pc
13 D 2.8 Kg - IP Abruption Grade III coagulatory Yes -- 10 U ffp
4 U plt
14 M 2.8 Kg - IP Bowel injury others -- -- 2 U pc
4 U pc
15 M 1.6 Kg - IP Impending DIC coagulatory Yes rent closure 6 U ffp
6 U plt
16 F 720g - AP Antepartum eclampsia HT Yes -- --
Imminent eclampsia with
17 M 1.05g + AP HT Yes -- --
uncontrolled Hypertenison
2 U pc
18 F 3.1Kg - IP Scar Ruptured uterus Uterine Yes --
4 U ffp
Abruption Grade II/Burst abdomen 3 U pc
19 F 1.4 Kg + PP others Yes --
(Mass closure after PND-10days) 6 U ffp
2 U pc
20 D 2 Kg - IP Abruption Grade III coagulatory Yes --
6 U ffp
21 M 2.6 Kg - AP Antepartum eclampsia HT Yes -- --
22 F 2.8 Kg - AP Imminent eclampsia HT Yes -- --
2 U pc
23 D 1.2 Kg - IP Abruption Grade III coagulatory Yes --
4 U ffp
2 U pc
24 F 1 Kg - IP Abruption Grade III coagulatory Yes --
4 U ffp
25 F 2.5 Kg - AP Severe Preeclampsia HT No -- --
26 M 3 Kg - AP Severe Preeclampsia HT No -- --
27 M 2.2 Kg - AP Severe Preeclampsia HT No -- --
28 M 2.7 Kg - AP Severe Preeclampsia HT No -- --
29 F 1.8 Kg - AP Severe Preeclampsia HT No -- --

Month: April
3 pallor++ A
Bp-160/100
1 Vanitha 32 415811 No -- G3P2L2 06/04/16 Hb 2.4g LN 17/04/16
2 Deepa 21 417074 Yes -- G2P1L1 3 17/04/16 SPO2-90% Em.Lscs 17/04/16 A
3 Em.Lscs --
3 Jesima Bagam 32 416797 Yes Referred P2L2 14/04/16 -- outside 14/04/16
2 Bp-170/110 A
4 Sangeetha 33 417342 Yes -- G3A2 19/04/16 RR-26/min Spon.Expulsion 20/04/16
1 Bp-80/50 Em.laparotomy/ --
5 Jayarani 33 417526 No -- Primi 20/04/16 PR-133/min salphingectomy 20/04/16
2 Spontaneous D
6 Sathya kala 29 417551 Yes -- G2P1L0 21/04/16 Bp-200/110 expulsion 22/04/16
1 Lap --
120/min salphingectomy
7 Anitha 25 417849 Yes -- G3P1L1A1 23/04/16 26/min done outside 23/04/16
8 Mary 22 417891 Yes Referred Primi 3 23/04/16 Bp-180/110 Em.Lscs 23/04/16 A
9 Lakshmi 27 418071 Yes Referred G3P2L1 2 25/04/16 Bp-160/120 Em.Rpt.Lscs 25/04/16 D
10 Surya 20 418196 Yes -- Primi 3 25/04/16 Bp-180/120 LN epi 26/04/16 A
11 Suganya 25 418277 Yes -- Primi 3 26/04/16 Bp-180/120 Em.Lscs 26/04/16 D
12 Bakiyam 25 418874 Yes Referred G3P1L1A1 3 30/04/16 Bp-150/100 Em.Rpt.Lscs 30/04/16 D
13 Senthamilselvi 25 415076 Yes -- Primi 3 01/04/16 - Em.Lscs 01/04/16 A
14 Kalaiyarasi 22 413292 Yes -- G2P1L1 3 19/03/16 - Elective Cs.Hys 02/04/16 A
15 Nisha 24 415270 Yes Referred G3P1L1A1 3 02/04/16 - Em.Lscs 02/04/16 A
16 Padhma 30 414410 Yes -- G3P1L1A1 3 27/03/16 - Em.Lscs 07/04/16 A
17 Nithya 21 415960 Yes -- G2P1L1 3 07/04/16 BP-180/110 LN Epi 09/04/16 A
18 Sasikala 23 416202 Yes -- Primi 3 09/04/16 BP-160/120 Em.Lscs 13/04/16 A
19 Kalaivani 27 416915 Yes -- Primi 3 15/04/16 BP-200/110 Em.Lscs 16/04/16 A
20 Valli 27 416946 Yes Referred Primi 3 16/04/16 BP-180/120 Em.Lscs 16/04/16 A
21 Dhanalakshmi 29 416985 Yes -- G5P4L3 3 16/04/16 BP-200/120 Em.Lscs 18/04/16 A
Month:April
S. Sex Weight NICU Timing Type of Event Type of ICU Surgical Blood
No of dysfunction intervention
Event caused
1 F 2 Kg - Severe Anemia/Postpartum eclampsia dysfunction 6 U pc
AP HT Yes - 4 U ffp
2 M 2.5 Kg - Rheumatic Heart Disease dysfunction
PP Severe MS with pulmonary edema CVS CPAP - -
3 -- -- - laprotomy done for internal bleeding dysfunction 10 U pc
Hrg 20 U ffp
-- Yes + 20 U plt
4 F 900g + severe preeclampsia dysfunction
AP HT Yes - -
5 -- -- - Ruptured ectopic with dysfunction 4 U pc
hemoperitoneum Hrg 3 U ffp
-- - 2 U plt
6 M 1 Kg - Abruption/Acute Kidney dysfunction 3 U pc
AP Injury/HELLP Renal Yes - 6 U ffp
7 -- -- - Ectopic/Post CPR/Pulmonary dysfunction
-- edema/L Pneumothorac RS Yes - 2 U pc
8 F 1.9 Kg + Antepartum eclampsia dysfunction
AP HT Yes - --
9 F 1 Kg - Previous 2 LSCS/Abruption Grade – dysfunction 3 U pc
II severe preeclampsia HT 6 U ffp
AP Yes - 4 U plt
10 F 1.5 Kg + Antepartum eclampsia dysfunction
AP HT Yes - --
11 1.7 Kg - Abruption Grade III/DIC dysfunction 3 U pc
HT 10 U ffp
F AP Yes - 6 U plt
12 1.2 Kg - Previous LSCSS dysfunction 2 U pc
M AP Abruption Grade III HT Yes - 6 U ffp
13 2 Kg + Central Placenta previa with bleeding dysfunction 5 U pc
Hrg 10 U ffp
M AP Yes - 10 U plt
14 2.6 Kg _ placenta accreta dysfunction 6 U pc
Hrg 6 U ffp
F IP Yes + 6 U plt
15 2.2 Kg - Type III placenta previa with bleeding dysfunction 5 U pc
F IP per vaginum Hrg Yes - 5 U ffp
16 2.2 Kg - Type III placenta previa dysfunction
F IP Hrg Yes - --
17 2.2 Kg - Severe preeclampsia dysfunction
F AP HT Yes - --
18 1.5 Kg + Severe preeclampsia dysfunction
F AP HT Yes - --
19 2.2 Kg - Severe preeclampsia + Uncontrolled dysfunction
F AP blood pressure HT Yes - --
M AP HT Yes - --
M AP HT Yes - --
Month: May
Referral OBS Vitals / Time of Alive/
S.No Name Age IP No B GA DOA Mode of Delivery
Status Score Inv Delivery Dead
1 Thilagavathi 23 419351 Yes Referred P2L2 3 02/05/16 pallor+ Lscs outside 04/05/16 --
BP-160/120
2 Ilakiya 24 419308 Yes Referred G2P2L2A1 3 04/05/16 Em.Lscs 04/05/16 D
Hb 6g
U 58
G2P1L1
3 Kalaivani 23 419230 Yes -- 3 03/05/16 C1.8 Em.Lscs 04/05/16 A
37wks
BP-160/120
SPO2-90%
4 Parimala 30 419224 No Referred G4P3L2 3 04/05/16 LN 05/05/16 A
Hb-5g
Em.Lscs
5 Devi 25 419584 Yes -- G2A1 3 05/05/16 BP-160/110 05/05/16 A
Breech
6 Krishnaveni 26 416736 Yes -- Primi 3 05/05/16 BP-200/110 LN 06/05/16 A
BP-140/100
7 Durga 25 417891 Yes Referred Primi 3 27/04/16 LN epi 07/05/16 A
Hb-5.4g
8 Anushya 21 419806 Yes Referred Primi 3 08/05/16 pallor+ Em.Lscs 08/05/16 D
pallor+ Partial
9 Sasibunisha 26 420059 Yes -- P2L2A1 1 09/05/16 09/05/16 --
Hb-6g salphingectomy
Uma
10 26 417160 Yes -- Primi 3 18/04/16 SPO2-92% Outlet 12/05/16 A
maheswari
11 Sakunthala 28 420328 Yes -- Primi 3 01/05/16 SPO2-80% LN epi 13/05/16 A
12 Rajalakshmi 22 420409 No Referred P3L2 2 13/05/16 Bp-160/110 spontaneous 14/05/16 A
expulsion
Bp-140/110
13 Gandhi 20 420211 No -- Primi 3 15/05/16 LN epi 16/05/16 A
Hb-5.5g
BP-170/120
14 Radhika 23 418975 Yes Referred Primi 3 01/05/16 LN 02/05/16 A
Hb-5g
15 Kaliyammal 35 415570 Yes -- G3P2L2 3 11/05/16 RBS-385 VBAC 14/05/16 A
BP-180/120
16 Anandhi 24 420270 Yes Referred Primi 3 10/05/16 Hb-4.8 Em.Lscs 13/05/16 A
CT increase
BP-140/100
17 Mariyammal 24 420270 No Referred P6L5 3 18/05/16 Lscs 19/05/16 A
Hb-4g
18 Kavitha 33 420745 Yes -- Primi 3 19/05/16 BP-180/110 Em.Rpt.Lscs 20/05/16 --
G4A3
19 Rubila 24 421424 Yes -- 3 19/05/16 BP-180/10 Em.Lscs 19/05/16 D
34wks
G2P2L1
20 Karthiga 15 420982 Yes -- 3 16/05/16 Bp-180/100 Em.Rpt.Lscs 17/05/16 A
33wks
Primi
21 Sulochana 28 420446 Yes -- 3 16/05/16 Bp-160/120 Em.Lscs 17/05/16 A
33wks
22 Saranya 22 420285 Yes Referred G2P1L1 3 16/05/16 SPO2-80% Em.Rpt.Lscs 17/05/16 A
pallor+
23 Devibala 30 420321 Yes -- G2P1L1A1 3 17/05/16 Em.Lscs 17/05/16 A
Hb-7g
Bp-180/110
24 Indrani 37 425986 Yes Referred G2A1 3 16/05/16 CT increase Em.Lscs 17/05/16 A
CR increase
Bp-200/100 Em.Hysterotomy
25 Vasumathy 28 412143 Yes Referred G2A1 2 18/05/16 18/05/16 A
TRFT Em.Lscs
G3P2L0A1
26 Anushya 34 445151 Yes Referred 2 20/05/16 BP-150/100 Em.Hysterotomy 20/05/16 D
Prev2 Lscs
BP-150/110
Hb-8g
27 Senthamilselvi 32 421446 Yes Referred G2A1 3 21/05/16 Lscs done outside 21/05/16 A
U-68
C-22
28 Joy 24 421976 Yes -- G2A1 3 22/05/16 BP-180/120 Em.Lscs 22/05/16 A
29 Suguna 25 421576 Yes Referred G4P3L1 3 24/05/16 BP-230/130 Em.Rpt.Lscs 25/05/16 A
BP-160/110
30 Kowsalya 23 422209 Yes Referred Primi 2 25/05/16 Em.Hysterotomy 25/05/16 D
Hb-6g
31 Muthalagu 28 422271 Yes -- Primi 3 26/05/16 Bp-180/120 Em.Lscs 27/05/16 A
32 Sakunthala 29 416543 Yes -- Primi 3 26/05/16 SPO2-76% Em.Lscs 27/05/16 A
G3P1L1A1 BP-180/120
33 Sangeetha 31 422675 Yes Referred 3 27/05/16 Em.Rpt.Lscs 27/05/16 A
Breech Hb-8g
Hb-6g
34 Brindha 24 422527 Yes Referred Primi 3 28/04/16 Em.Lscs 01/05/16 A
plt-60000
Primi
35 Ilakiya 25 422316 Yes Referred 3 29/04/16 plat-23000 Em.Lscs 01/05/16 -
Twins
36 Manimegalai 32 418978 No -- Primi 1 01/05/16 Hb-5.5g Em.Lep 01/05/16 -
N
37 Nancy 30 423140 Yes -- G3P2L2 3 31/05/16 TA++ 31/05/16 A
Hb-9.5g
Bp-70/50
38 Murugeswari 28 419873 No -- G2P1L1 1 07/05/16 Em.Lep 07/05/16 -
Hb-5g
39 Sudha 36 419883 Yes -- G3P2L2 3 04/05/16 Bp-180/120 LN 04/05/16 A
40 Jessi 35 419326 No -- G3P2L2 1 04/05/16 Hb-5.2g Em.Lep 05/05/16 -
41 Visalatchi 25 419280 Yes Referred G3P2L1 3 03/05/16 Bp-160/110 Em.Lscs 04/05/16 A
42 Sudha 25 419863 Yes Referred Primi 3 07/05/16 Bp-150/110 outlet forceps 08/05/16 A
BP-90/60 Em.Rpt.Lscs
43 Akila 32 419996 Yes -- G3P2L1 3 09/05/16 13/05/16 A
Hb-6.6g B/L U/A
44 Ranjani 25 421122 Yes -- G2P1L0 3 17/05/16 Bp-160/110 LN epi 17/05/16 A
G2P1L1
45 Jayanthi 27 421020 Yes -- 2 17/05/16 Bp-180/110 Em.Hysterotomy 17/05/16 -
30wks
Month:May
Timing Type of
S. Surgical
No intervention
Event caused
1 -- -- - PP Purperal Sepsis sepsis Yes - 3 U pc
3 U pc
2 M 2.5 Kg - IP Abruption/Impeding DIC coagulatory Yes - 6 U ffp
4 U plt
Severe preeclampsia with impending Renal
3 M 2.9 Kg - AN Renal Yes - -
failure
4 M 3.2 Kg - PN Anemia/Congestive cardiac failure cva Yes - 4 U pc
2 U pc
5 M 1.8 Kg AN Severe preeclampsia/Impending DIC coagulatory Yes -
6 U ffp
6 M 1.9 Kg + AN Severe preeclampsia/GHT severe anemia coagulatory Yes - --
7 F 2.2 Kg + AN Yes - 5 U pc
2 U pc
8 F 2 Kg - IP Abruption Grade III coagulatory Yes -
4 U ffp
R ectopic gestation ruptured with 4 U pc
9 -- -- - -- hrg Yes -
hemoperitoneum 4 U ffp
RHD-Severe MS/BMV done with
10 F 2.2 Kg - AN CVS Yes - --
pulmonary edema
RHD-Severe MS/MR with congestive CAP
11 F 2 Kg - PP CVS - --
cardiac failure MV
12 F 900g + PP postpartum eclampsia HT -- - --
13 M 3 Kg + PP Severe anemia/postpartum eclampsia HT -- - 5 U pc
4 U pc
severe preeclampsia/anemia/acute kidney 10 U
14 M 2.5 Kg - AP coagulatory Yes -
injury recovered Impending DIC ffp
10 U plt
Overt Riabetes Mellitus/DKA(Diabetic
15 F 2 Kg - AP Others Yes - --
Ketoacidosis)
2U pc
Impending DIC/severe 10 U
16 M 2 Kg - IP coagulatory Yes -
preeclampsia/HELLP ffp
6 U plt
Severe anemia with congestive cardiac
17 F 2 Kg - AP cvs CPAP - 5 U pc
failure/GHT(Gestational hypertension)
18 -- 1.7 Kg + AP severe preeclampsia HT -- - --
3 U pc
19 F 1.4 Kg - AP Abruption Grade III coagulatory Yes - 10 U
ffp
20 M 1.5 Kg + AP severe preeclampsia HT -- - --
21 M 1.3 Kg + AP Antepartum eclampsia HT Yes - --
severe Lower Respiratory
5 U pc
22 F 2.8 Kg - PP Infection/Pulmonary edema/Gestational RS CPAP -
4 U ffp
Diabetes Mellitus
Type III placenta previa with bleeding per 1 U pc
23 F 2.2 Kg - IP hrg Yes -
vaginum 6 U ffp
Impending DIVC/ severe preeclampsia 2 U pc
24 F 3.3 Kg - AP coagulatory Yes -
Abruption Grade III 4 U ffp
Imminent eclampsia with impending Acute
25 M 3.3 Kg - AP RS Yes - --
Respiratory Failure
2 U pc
26 F 500g - AP Abruption Grade III coagulatory Yes -
4 U ffp
4U pc
16 U
27 F 2.5 Kg - AP HELLP/ARF/Jaundice/Hyperthyroid/DIVC Hepatic Yes -
ffp
12 U plt
28 M 2.2 Kg - AP Imminent eclampsia HT -- - --
severe eclampsia, Hypertensive
29 F 1.2 Kg + AP HT Yes - --
encephalopathy
2U pc
30 M 500g - AP Imminent eclampsia/HELLP HT -- -
6 U ffp
31 F 1.8 Kg + AP Imminent eclampsia HT -- - --
Pulmonary edema resolved
32 M 3 Kg - PN RHD-Moderate MS/severe MR/Moderate CVS Yes - --
PHT
33 M 2.8 Kg - AP Severe preeclampsia HT -- - 2U pc
2 U pc
34 M 3 Kg - PP HELLP coagulatory Yes - 6 U ffp
6 U plt
2U pc
35 M 2.5 Kg - AP EHPVO/Thrombocytopenia Hepatic Yes -
10 U plt
L partial salphingectonmy 3U pc
36 - -- - -- hrg -- -
L total ectopic 4 U ffp
4U pc
37 M 2.4 Kg - IP postpartum haemorrhage/placenta previa hrg Yes + 6 U ffp
6 U plt
4U pc
Right ectopic pregnancy with
38 - -- - -- hrg Yes - 16 U
hemoperitoneum
ffp
39 F 1.2 Kg + AP Imminent eclampsia HT Yes - --
4U pc
40 - -- - -- Right ectopic pregnancy Hrg Yes - 4 U ffp
2 U plt
41 F 1.6 Kg + AP severe eclampsia HT -- - --
1.75 severe eclampsia/Intrauterine Growth
42 M + AP HT Yes - --
Kg Restriction
4U pc
Type III central placenta previa with
43 F 1.3 Kg + AP hrg Yes - 6 U ffp
bleeding per vaginum
4 U plt
1U pc
44 F 2.7 Kg - AP Grade III Abruption placenta coagulatory Yes -
6 U ffp
16 U
45 F 900g + AP Imminent eclampsia/Impending DIVC coagulatory -- -
ffp
Month: June
S.No Name Age IP No B Referral OBS GA DOA Vitals / Inv Mode of Time of Alive/
3 Bp-100/70 A
SPO2-80% Outlet forceps
1 Vedanayagi 25 423184 Yes Referred Primi 01/06/16 cout-02 delivery 01/06/16
3 SPO2-92% A
c-2 outlet forceps
2 Savitha 26 423241 Yes Referred Primi 02/06/16 Hb-6g epi 02/06/16
3 pallor+++ A
Bp-150/90
Severe CRI
3 Rani 30 423621 No Referred G3P2L2 02/06/16 1.7g/dl LN 15/06/16
3 pallor+++ Lscs done -
4 Nancy Soniya 30 423140 Yes Referred P2L2A1 31/05/16 Hb-4.8g outside --
2 Bleeding p/v+ D
pallor+
5 Veeraselvi 28 423780 Yes Referred G3P2L2A0 04/06/16 Hb-4.8g Em.Hysterotomy 04/06/16
G4P3L1 3 pallor+ A
6 Vasambal 30 424009 Yes Referred Prev 3Lscs 06/06/16 Hb-5.5g Hysterotomy 10/06/16
7 Pasubathy 40 424384 No -- G2P1L1 1 07/06/16 Hb-3.6g MVA 07/06/16 -
1 Bleeding p/v -
Fever
increasing
8 Dhanalakshmi 42 424413 No Referred P2L2A1 07/06/16 RFT Exploratory Lap. ARDS
Manthira 3 A
9 Kumari 30 424605 Yes Referred G3P2L1 09/06/16 -- Em.Rpt.Lscs 10/06/16
1 Digital evac -
pallor+ with check
10 Malaiyathal 35 425069 No Referred G3P2L2 13/06/16 Hb-5.8g curettage 13/06/16
1 unmarried -
11 Sasikala 23 423954 No -- Primi 05/06/16 Hb-5g Em.Lap 05/06/16
2 Em.Rpt.Lscs D
12 Pandiyammal 26 424582 Yes -- G2P1L1 09/06/16 Bp-160/100 U/A.Lig 14/06/16
13 Kowsalya 22 423627 Yes Referred Primi 3 03/06/16 Bp-170/110 Em.Lscs 03/06/16 A
14 Ra,ua 25 423734 Yes Referred Primi 3 03/06/16 Bp-180/120 Em.Lscs 04/06/16 A
3 Bp-160/100 Em.Lscs D
pallor+
15 Selvi 25 424010 Yes Referred Primi 06/06/16 Hb-6g 06/06/16
3 Bp-160/110 Em.Lscs A
16 Akila 24 424159 Yes Referred Primi 06/06/16 Hb-7g 07/06/16
3 BP-200/120 Em.Lscs A
17 Gokila 23 424648 Yes -- G2P1L1 09/06/16 Hb-8g B/Ls 09/06/16
18 Malligai 20 424419 Yes -- Primi 3 08/06/16 Bp-180/110 Em.Lscs 10/06/16 A
3 Em.Rpt.Lscs A
Subtotal
19 Nirosha 27 424932 Yes Referred G3P1L1A1 11/06/16 Bp-90/60 hysteron 11/06/16
20 Nandhini 24 429339 Yes Referred P1L1 3 27/06/16 BP-180/100 LN 01/06/16 A
P4L3 3 Bp-140/80 Em.Lscs outside A
21 Priya 26 429303 Yes Referred 6th DOD 26/06/16 headache 27/06/16
22 Amudha 21 428620 Yes Referred Primi 3 21/06/16 Bp-180/120 Em.Lscs 20/06/16 D
23 Shakila Banu 24 428661 Yes -- Primi 3 21/06/16 Bp-170/120 Em.Lscs 21/06/16 A
3 Em.Lscs A
24 Chitra 32 428673 Yes -- G2A1 21/06/16 Hb-6.8g B/L U/A 21/06/16
3 pallor+ LN A
25 Vellayi 27 428653 Yes Referred G2P1L1 22/06/16 Hb-5.6g 22/06/16
26 Gunasundari 20 428818 Yes -- Primi 23/06/16 Hb-5.5g 23/06/16
3 Em.Lscs A
27 Mounika 29 428163 Yes Referred G2P1L1 19/06/16 N 23/06/16
G2A1 3 Em.Lscs A
28 Mithila 25 428912 Yes Referred Twins 23/06/16 Bp-180/110 24/06/16
3 Bp -200/120 Em.Lep D
PT,CT,CRT
29 Revathi 28 429000 Yes Referred Primi 24/06/16 increase 24/06/16
30 Periyanayagi 24 428915 Yes -- Primi 3 23/06/16 Bp-160/110 Em.Lscs 27/06/16 A
31 Gunaselvi 28 429442 Yes -- Primi 3 27/06/16 Bp-220/130 Em.Lscs 27/06/16 A
3 Em.Lscs A
32 Radhiga 28 429083 Yes -- Primi 24/06/16 Bp 190/120 B/L U/A 29/06/16
3 Em.Lscs D
33 Gunasundari 24 429486 Yes -- Primi 27/06/16 Bp150/110 contracted pelvis 29/06/16
3 Bp 160/110 Em.Lscs A
34 sangeetha 21 429413 Yes -- Primi 27/06/16 Hb-6g B/L O/A 30/06/16
2 Em.Hysterotomy D
35 veeraselvi 28 423780 Yes -- G3P2L2 04/06/16 Bp 150/110 B/L 04/06/16
36 Rashayi 39 424353 No Referred G3P2L2 1 07/06/16 Bp 90/50 Em.Lep 09/06/16 -
37 Rani 32 427571 Yes -- Primi 1 15/06/16 Bp 70/50 Em.Lep 15/06/16 -
38 Gowri 23 428401 Yes Referred Primi 3 17/06/16 Bp 200/120 LN epi 19/06/16 A
39 Renuka 20 428411 Yes Referred P2L2 3 18/06/16 -- Lscs outside 18/06/16 A
40 Nooorjahan 20 424900 Yes Referred G2P1L1 3 10/06/16 Bp 180/120 LN 10/06/16 A
41 Meena 25 429674 Yes Referred G2A1 3 28/06/16 Bp 160/100 Em.Lscs 28/06/16 A
Month:June
Event caused
1 F 3.2 Kg - Large ASD/Severe PHT(Pulmanary
AN Hypertension) cvs CPAP -- --
2 F 2.4 Kg - IP severe MS/MR/GHT/Anemmia cvs Yes -- 3 U pc
3 M 1.75 Kg + severe GHT/Anemmia AP eclampsia 14 U pc
AN + postpartum eclampsia HT MSO4 -- 14 U plt
4 -- -- - Type IV placenta previa with Atonic 6 U pc
postpartum haemorrahage 2 U ffp
IP hrg Yes TAH 6 U plt
5 F 800g - Abruption grade III 5 U pc
IN coagulatory Yes -- 4 U ffp
6 M 2.1 Kg - Central placenta previa with bleeding 7 U pc
per vaginum 8 U ffp
7 -- -- - Incomplete abortion/severe anemic
-- shock hrg Yes -- 5 U pc
8 -- -- - septic abortion/shock/sigmoid loop MV
-- colostomy with rectal injury sepsis CPAP -- 4 U pc
9 F 2.7 Kg - central placenta previa 6 U pc
6 U ffp
10 -- -- - -- Retained placenta/septic abortion sepsis Yes -- 3 U pc
11 -- - Ruptured ectopic
-- -- pregnancy/Hypovolemic shock hrg Yes -- 4 U pc
12 800g - Previous LSCS/III Abruption 2 U pc
M -- coagulatory -- -- 4 U ffp
13 M 3.2 Kg + AP Severe preeclampsia HT -- -- --
14 F 1.2 Kg + AP Imminent eclampsia HT -- -- --
15 2 Kg - Abruption Grade III/Shoulder coagulatory 2 U pc
F IP Presentaion Yes -- 4 U ffp
16 2.5 Kg - Severe preeclampsia/Mild atonic HT
F AP postpartum haemorrhage -- -- --
17 M 3.5 Kg - AP Antepartum eclampsia HT -- --
18 M 1.6 Kg + AP Antepartum eclampsia HT Yes -- --
19 3.1 Kg - atonic postpartum haemorrhage hrg 5 U pc
6 U ffp
M PP Yes TAH 6 U plt
20 F 3.2 Kg - PP postpartum eclampsia HT Yes -- --
21 2.3 Kg - Cerebral Venous HT
M PP Thrombosis/postpartum eclampsia Yes -- --
22 F 1.7 Kg - AP Antepartum eclampsia HT Yes -- --
23 M 1.6 Kg + AP Twin,Abruption Grade III coagulatory Yes -- --
24 2.4 Kg - Type III posterior placenta previa Hrg 5 U pc
M IP with bleeding per vaginum Yes -- 4 U ffp
25 1.6 Kg - Abruption Grade III coagulatory 3 U pc
M AP Yes -- 6 U ffp
26 2.6 Kg - Antepartum eclampsia/failed HT
M AP induction Yes -- --
27 2.7 Kg - Central placenta previa with increta Hrg 3 U pc
6 U ffp
M IP Yes TAH 6 U plt
28 M 2.4 Kg - severe preeclampsia HT
M 1.8 Kg + AP -- -- --
29 1.2 Kg - Abruption Grade III/DIC coagulatory 3 U pc
6 U ffp
M AP Yes -- 4 U plt
30 M 3.9 Kg - AP severe preeclampsia/Breech HT -- -- 1 U pc
31 1.7 Kg + severe preeclampsia with uncontrolled HT
F AP BP Yes -- 2 U pc
32 2.1 Kg + severe preeclampsia with uncontrolled HT
F AP blood pressure Yes -- --
33 F 2.4 Kg - AP Abruption/Intrauterine death coagulatory Yes -- --
34 2.6 Kg - Abruption Grade III coagulatory 2 U pc
F AP Yes -- 4 U ffp
35 800g - Abruption Grade III coagulatory 2 U pc
M AP Yes -- 6 U ffp
36 -- - L Ruptured ampellary ectopic Hrg 4 U pc
-- -- pregnancy Yes -- 4 U ffp
37 -- - Right ruptured ectopic pregnancy/ hrg
-- -- severe preeclampsia Yes -- 3 U pc
38 2.9 Kg - placenta previa Type III with hrg
M AP postpartum haemorrhage Yes -- --
39 F 2.8 Kg - IP Antepartum eclampsia HT Yes TAH --
40 F 2 Kg + AP Antepartum eclampsia HT Yes -- --
41 3 Kg - Antepartum eclampsia/Unfavourable HT
M AP cervix -- -- --
Month: July
1 Uma Gandhi 28 428899 Yes -- G2P1L1 3 23/06/16 -- Em.Lap 02/07/2016 A
2 Lakshmi 20 430281 Yes -- Primi 3 03/07/16 -- Em.Lscs 03/07/2016 A
3 Suganya 23 430266 Yes -- Primi 3 03/07/16 Bp-170/120 Em.Lscs 03/07/2016 A
4 Kala 29 430528 Yes -- G3P1L1A1 3 05/07/16 Bp-160/120 Em.Rpt.Lscs 05/07/2016 A
5 Kumudha rani 32 430687 Yes Referred G2A1 3 05/07/16 Bp- 200/120 Em.Lscs 06/07/2016 A
Hb-4g
6 Sudha 23 430516 Yes -- G2P1L1 3 04/07/16 Em.Rpt.Lscs 05/07/2016 A
Bp-160/100
3 Em.Rpt.Lscs A
TAH+
Bladder rent
7 Ponnammal 35 422842 Yes -- G2P1L1 28/05/16 -- repair 07/07/2016
3 A
8 Sumathi 25 428108 Yes -- G2P1L1 23/06/16 Bp-200/120 Em.Rpt.Lscs 08/07/2016
3 A
9 Rajalakshmi 32 431776 Yes -- G4P1L1A1 13/07/16 -- Em.Caes.Hys 13/07/2016
3 A
10 Rajeswari 23 431656 Yes -- G4P1L1A2 13/07/16 -- Em.Cys.Hys 14/07/2016
3 A
11 Nishanthi 26 430993 Yes -- G2A1 08/07/16 Hb-6g Em.Lscs 15/07/2016
3 Em.Lscs D
12 Sangavi 21 431983 Yes -- G2A1 15/07/16 Bp-200/120 Blynch 15/07/2016
13 Manimegalai 26 432204 Yes -- G3P2L2 3 16/07/16 -- Em.Lscs A
17/07/2016
A
14 Sathya 24 432276 Yes -- Primi 3 17/07/16 Bp-160/110 Em.Lscs
18/07/2016
15 Vijalakshmi 29 432454 Yes -- G2P1L1 3 18/07/16 Bp-200/110 Em.Rpt.Lscs A
18/07/2016
3 Em.Lscs A
16 Gowri 27 423467 Yes -- G2P1L1 19/07/16 Bp-160/110 19/07/2016
3 Em.Lscs D
17 Malairani 32 430196 Yes Referred Primi 14/07/16 Bp-130/80 18/07/2016
3 Bp-100/70 Em.Lap A
18 Dhivya 20 432617 Yes Referred P1L1 20/07/16 130/min peri partum hyst 19/07/2016
3 Bp-150/80 LN epi A
19 Saranya 26 432199 Yes Referred Primi 17/07/16 Hb-9g Hep A+ve 17/07/2016
3 Bp-120/70 Lscs outside A
PR-117
20 Ambika 24 433021 Yes Referred P1L1 23/07/16 o2-97% 22/07/2016
1 Em.Lep -
21 Sridevi 22 430650 Yes -- G3P2 06/07/16 Bp-80/50 06/07/2016
3 Em.Lscs A
22 Ilakkiya 23 433734 Yes Referred Primi 28/07/16 Bp-140/120 28/07/2016
3 Em.Hys D
23 Umadevi 30 432976 Yes -- G2P1L1 22/07/16 Bp-80/50 26/07/2016
3 Em.Lscs D
24 Muthulakshmi 26 433753 Yes -- G2P1L1 28/07/16 -- 28/07/2016
3 Em.Lscs A
25 Bhuvaneshwari 24 433428 Yes -- Primi 25/07/16 Bp-160/110 26/07/2016
Hb-4.3g
26 Anitha 24 433891 Yes Referred G2P1L1 28/07/16 28000 28/07/2016
2 RR-52/min Em.Lscs A
Hb-2.6g
U-98
C-23
27 Seetha 24 434012 Yes -- Primi 31/07/16 52000 31/07/2016
3 LN A
28 Amudha 22 428990 Yes Referred Primi 01/07/16 Bp-180/110 01/07/2016
3 LN A
29 Savitha 21 429911 Yes Referred G2A1 02/07/16 Bp-160/120 03/07/2016
0 Bp-200/120 LN D
30 Kavitha 26 430112 Yes Referred G2P1L0 04/07/16 04/07/2016
Month:July
Timing Type of
S. Surgical
No intervention
Event caused
4 U pc
1 M 3Kg - IP Atonic postpartum haemorrahage hrg Yes + 6 U ffp
6 U plat
Type III posterior placenta previa
2 M 2 Kg - IP hrg Yes - 3 U pc
with bleeding per vaginum
3 M 2.4 Kg - AP Imminent eclampsia HT Yes - 1 U pc
4 F 1.9 Kg + AP Imminent eclampsia HT Yes - 2 U pc
5 M 1.6 Kg + AP Severe preeclampsia/Twins HT Yes - 2 U pc
Gestational Hypertension with

6 F 2.8 Kg - AP HT Yes - 6 U ffp
HELLP
5 U pc
7 F 1.6 Kg + IP Placenta accreta hrg Yes TAH 6 U ffp
6 U plat
5 U pc
central placenta previa with bleeding
8 F 1.6 Kg + IP hrg Yes - 6 U ffp
per vaginum
4 U plat
4 U pc
9 M 3 Kg - IP placenta accreta hrg Yes - 6 U ffp
6 U plat
5 U pc
10 F 2.7 Kg - IP Atonic postpartum haemorrahage hrg Yes - 4 U ffp
4 U plat
Type III placenta previa with bleeding 4 U pc
11 M 3.2 Kg - IP hrg -- +
per vaginum 4 U ffp
2 U pc
12 M 1.5 Kg + IP Abruption Grade III HT Yes -
6 U ffp
Type III placenta previa with bleeding 4 U pc

13 F 2.8 Kg - IP hrg -- -
per vaginum/ 4 U ffp
14 F 3.5 Kg - AP Severe preeclampsia HT -- - --
15 1.4 Kg - Gestational Hypertension/ Abruption HT

M IP Grade III Yes - --
Abruption/Intrauterine Death/
17 F 1.6 Kg - PP HT Yes - --
postpartum eclampsia
5 U pc
Ruptured uterus with
18 M 3.4 Kg - IP uterine Yes TAH 10 U ffp
hemoperitoneum
4 U plat
DCDA/vulval hematoma 4 U pc
19 M 2 Kg + PP exploration/Jaundice complicating Hepatic Yes - 19 U ffp
Hepatic Encephalopathy 3 U plat
postpartum eclampsia/cerebral venous
20 M 2.4 Kg - PP HT Yes - --
Thrombosis
4 U pc
21 -- -- - -- Ruptured Left ectopic pregnancy hrg Yes -
4 U ffp
Antepartum eclampsia with
22 F 2.7 Kg - AP HT Yes - --
uncontrolled BP
5 U pc
23 F 2.5 Kg - IP scar rupture/Rent closure uterine Yes + 10 U ffp
6 U plat
2 U pc
24 M 3.1 Kg - IP Abruption Grade III Hrg Yes -
6 U ffp
25
F 2.8 Kg - AP Severe preeclampsia HT -- - --
26 4 U pc
Antepartum eclampsia/DIC/Acute
M 1.8 Kg + IP renal Yes - 11 U ffp
Kidney Injury(AKI)
6 U plat
27 4 U pc
Severe preeclampsia/HELLP
F 1.2 Kg - AP Renal Yes - 10 U ffp
syndrome/Acute Kidney Injury(AKI)
4 U plat
28
Severe preeclampsia with mild pulm
M 2 Kg + AP HT / RS Yes - -
edema
29
F 2.5 Kg - AP Severe preeclampsia / LRI HT Yes - -
30
Abruption Gr – III with impending 4 U pc
M 2.8 Kg - IP coag Yes -
DIC 6 U ffp
Month: August
1 Sathya 25 383031 Yes Referred G2A1 3 06/08/2015 Stable Em.Lscs 06/08/15 A
3 pallor++ D
Hb-4g
2 Sasikala 22 383284 Yes -- Primi 07/08/2015 pt increase Em.Lscs 07/08/15
3 Mala 34 383211 Yes -- G3P2L2 3 07/08/2015 pallor+ Em.caesa.Hys 08/08/15 A
4 Sivaranjani 28 383350 Yes -- Primi 3 08/08/2015 Bp-170/120 Em.Lscs 09/08/15 A
5 Mangayarkarasi 26 383458 Yes -- G2P1L1 3 09/08/2015 -- Em.Lscs 09/08/15 A
3 pallor++ D
Bp-180/120
Hb-5.2g
PT,CT
6 Maheswari 38 383943 Yes -- G3P1L1A1 12/08/2015 increase Em.Rpt.Lscs 12/08/15
3 pallor++ D
Hb-4g
PT,CT
7 Ramya 24 384008 Yes -- G3P2L1 13/08/2015 increase Em.Lap 13/08/15
3 pallor+ A
Hb-7g
8 Barakath Nisha 25 384737 Yes Referred Primi 19/08/2015 pt increase Em.Lscs 20/08/15
9 Kavitha 30 385059 Yes Referred Primi 3 21/08/2015 Bp-180/110 C.Hys 21/08/15 A
10 Ilavarasi 28 385569 Yes Referred G4P2L2A1 3 25/08/2015 -- Em.Lscs TAH 25/08/15 A
3 Bp-200/120 A
11 Chandrakala 20 385561 Yes -- G2A1 25/08/2015 Hb-8g Em.Lscs 25/08/15
3 Bp-190/110 A
12 Shamathi 21 385667 Yes -- Primi 24/08/2015 Hb-7.9g Em.Lscs 24/08/15
13 Subha 21 385329 Yes Referred Primi 3 23/08/2015 Bp-190/120 Em.Lscs 23/08/15 D
14 Kavitha 20 385406 Yes Referred Primi 3 23/08/2015 Bp-200/110 Em.Lscs 24/08/15 A
15 Vanaroja 36 385767 Yes -- G2A1 26/08/2015 Hb-6.8g 27/08/15
3 Hb-8g Em.Lscs A
G2P1L1 Liver
16 Maheswari 27 385878 Yes Referred Twins 27/08/2015 emergence 27/08/15
17 Ilayarani 26 386013 Yes Referred G2P1L1 3 28/08/2015 Bp-180/110 Em.Lscs 28/08/15 A
PT,CT
18 Vaduvammal 26 386104 Yes -- G3A2 28/08/2015 increase 28/08/15
19 Pown 31 383356 Yes -- G4P2L1A1 3 08/08/2015 Bp-100/60 Em.Lscs 08/08/15 A
20 Anushya 25 385880 Yes -- G2P1L1 3 27/08/2015 -- Em.Lscs 29/08/15 A
21 Kalviyarasi 24 386499 Yes -- Primi 3 31/08/2015 Bp-170/120 Em.Lscs 31/08/15 A
P2L0A1 11 -- -
Expelled Bp-180/110
22 Sudha 30 386431 Yes -- outside 31/08/2015 PT increase 31/08/15
23 Sathyapriya 23 382148 Yes Referred Primi 3 02/08/2015 PT increase Em.Lap 03/08/15 A
24 Ramani 28 383280 No -- G2P1L1 1 06/08/2015 Hb-5.2g MVA -- -
25 Savithri 26 384012 No -- G3P2L2 1 13/08/2015 Hb-4.8g MVA -- -
26 Radhika 20 385870 No -- G2A1 1 15/08/2015 Hb-6.8 MVA -- -
27 Shanthi 24 383381 Yes Referred Primi 3 20/08/2015 Bp-160/120 LN epi 21/08/15 A
G2P1L1 3 Em.Laparotomy A
28 Deepika 25 386190 Yes -- Prev Lscs 31/08/2015 -- 31/08/15
29 Chitra 26 384107 Yes -- G6P5L5 1 19/08/2015 Hb-6.8g -- 19/08/15 -
G3P2L1 3 Em.Lscs.Laparo A
30 Sathyapriya 23 382148 Yes -- Breech prom 01/08/2015 -- tomy 01/08/15
31 Chinnamani 32 382552 No -- G2P1L1 1 02/08/2015 Hb-5g Em.Lap 02/08/15 -
32 Susila 31 383032 Yes Referred G3P2L2 3 06/08/2015 Bp-170/110 Em.Lscs 06/08/15 A
33 Rani 35 383184 Yes -- G4P3L3 3 06/08/2015 Bp-180/120 Em.Hys TAH 06/08/15 A
34 Jaya 32 384723 No -- Primi 1 18/08/2015 Hb-4.4g Em.Lap 19/08/15 -
3 Bp-180/120 Em.Hys A
35 Dhanalakshmi 25 384477 Yes Referred G3P2L2 19/08/2015 CT increase 19/08/15
36 Maheswari 26 385806 No Referred G2P1L1 1 26/08/2015 -- Em.Laparotomy 26/08/15 -
37 Ragima 25 386392 No Referred G4P3L3 1 30/08/2015 -- MVA 30/08/15 -
38 Jayaradha 21 385175 No Referred Primi 1 21/08/2015 -- MVA 21/08/15 A
Month:August
Event caused
1 M 3.2 Kg - Central Placenta Previa with Bleeding Hrg 5 U pc
per vaginum 4 U ffp
IP Yes - 4 U plat
2 F 1.2 Kg - Abruption Grade III HT 6 U pc
6 U ffp
IP Yes - 10 U plat
3 M 1.1 Kg + Central Placenta Previa with atonic hrg 5 U pc
postpartum haemorrhage 4 U ffp
IP Yes C.Hys 4 U plat
4 F 1.25 Kg + AN Imminent eclampsia HT -- - --
5 F 1.8 Kg + 1st Twin breech/ atonic postpartum hrg
F 1.5 Kg IP haemorrhage Yes Conservative 5 U pc
6 M 1.7 Kg - Abruption Grade III/Impending DIC coagulatory 3 U pc
10 U ffp
IP Yes - 4 U plat
7 F 3.2 Kg - Abruption/DIC/ atonic postpartum coagulatory 6 U pc
haemorrhage 10 U ffp
IP Yes TAH 12 U plat
8 F 2.6 Kg - Antepartum eclampsia HT 2 U pc
AN MV - 4 U ffp
9 F 2.7 Kg - Monochorionicchiono Amniotic hrg 4 U pc
F 1.9 Kg twins, atonic postpartum haemorrhage 6 U ffp
IP failed medical treatment Yes C.Hys 6 U plat
10 F 2.3 Kg - Type III placental previa/ atonic hrg 4 U pc
IP Yes TAH 6 U plat
11 M 1.9 Kg + AN Imminent eclampsia HT -- - 1 U pc
12 F 3.2 Kg - AN Imminent eclampsia HT -- - 2 U pc
13 M 1.7 Kg + AN Antepartum eclampsia HT Yes - --
14 M 2.4 Kg - AN Imminent eclampsia HT -- - --
15 2.5 Kg - Abruption Grade III hrg 5 U pc
4 U ffp
M AN Yes - 4 U plat
16 3 Kg - HELLP/failed induction hepaticHT 2 U pc
12 U ffp
M AN Yes - 4 U plat
18 1.5 Kg + Abruption Grade III with atonic Hrg 3 U pc
postpartum haemorrhage/increasing 6 U ffp
M IP RFT/AKI Yes Hayman 4 U plat
19 2.7 Kg - Type III placental previa with hrg 4 U pc
bleeding per vaginum 4 U ffp
F IP Yes - 4 U plat
20 2.8 Kg -- central placenta previa with bleeding hr 4 U pc
per vaginum 4 U ffp
M IP Yes - 3 U plat
21 2.6 Kg - Antepartum eclampsia HT
M AN Yes - --
22 - - Abruption Grade III/DIC coagulatory 5 U pc
8 U ffp
F IP MV - 4 U plat
23 1.6 Kg + IUGR/Breech/PROM/DIC coagulatory 4 U pc
14 U ffp
M PN MV TAH 10 U plat
24 - - incomplete abortion/Hypovolemic Hrg
- -- shock -- MVA 5 U pc
25 - - incomplete abortion/Hypovolemic hrg
- -- shock -- - 5 U pc
26 - - incomplete abortion/Hypovolemic hrg
- -- shock -- - 3 U pc
27 2.5 Kg _ Severe preeclampsia HT
F -- -- - --
28 - - Type III placental previa with fundal hrg 4 U pc
perforation 6 U ffp
- IP -- TAH 6 U plat
29 - Sepsis septic shock with severe anemia sepsis 5 U pc
- -- ETT/MV - 4 U ffp
30 - hrg postpartum haemorrhage not hrg 5 U pc
responding to medical management 10 U ffp
- IP -- TAH 6 U plat
31 - - Left ruptured ectopic hrg 4 U pc
pregnancy/Hypovolemic shock 4 U ffp
- -- Yes 4 U plat
32 900g - Imminent eclampsia HT
F AN Yes - --
33 600g - Imminent eclampsia with atonic HT
F AN postpartum haemorrhage -- TAH --
34 - -- Right ruptured ectopic hrg 4 U pc
pregnancy/Hypovolemic shock 6 U ffp
-M -- Yes - 4 U plat
35 400g - Antepartum eclampsia/ Abruption HT 2 U pc
M AN Grade III Yes - 4 U ffp
36 - - Right ruptured ectopic hrg 4 U pc
- -- pregnancy/shock Yes - 4 U ffp
37 - - Incomplete abortion/Hypovolemic hrg
- -- shock -- - 3 U pc
38 - - Incomplete abortion/Hypovolemic hrg
- -- shock -- - 4 U pc
Month: September
3 Bp-170/120 A
1 Sudha 28 386726 Yes Referred Primi 02/09/2015 Hb-4.6g Em.Lscs 02/09/2015
2 Vanitha 29 381111 Yes -- G4P3L3 3 21/07/2015 Hb-6.8g Em.Lscs 02/09/2015 A
3 Sathya 20 386846 Yes -- G2P1L1 3 02/09/2015 Bp-180/120 Em.Rpt.Lscs 02/09/2015 A
4 Sumathi 30 386931 Yes -- G4P2L1A1 3 03/09/2015 -- Em.Lscs 04/09/2015 A
5 Deivamani 40 387228 Yes Referred G2P1L1 3 05/09/2015 Bp-170/110 Em.Rpt.Lscs 05/09/2015 D
6 Praba 29 386884 Yes -- G2P1L1 3 03/09/2015 Hb-6g Em.Lscs 06/09/2015 A
3 Bp-200/120 A
7 Sarala 30 387206 Yes -- G2P1L1 05/09/2015 Hb-7g Em.Rpt.Lscs 07/09/2015
3 Bp-160/110 A
8 Ramya 25 387454 Yes Referred Primi 07/09/2015 U/A 3+ Em.Lscs 07/09/2015
9 Ambika 32 387515 Yes -- G3P2L1 3 09/09/2015 -- Em.Lscs 09/09/2015 A
10 Mahalakshmi 25 387818 Yes Referred G2P1L1 3 10/09/2015 -- Em.Rpt.Lscs 10/09/2015 A
3 Bp-170/120 D
CT,PT
11 Pragadeeshwari 22 387729 Yes -- G2A1 9/09/2015 increase Em.Lscs 10/09/2015
12 Chinnamayil 27 387883 Yes -- G2P1L1 3 10/09/2015 Bp-200/120 Em.Lscs 10/09/2015 D
13 Muthumani 29 388132 Yes Referred G3P2L1 3 12/09/2015 Bp-190/120 Em.Lscs 12/09/2015 A
14 Jayabharathi 22 388457 Yes -- Primi 3 14/09/2015 Bp-180/110 Em.Lscs 14/09/2015 D
15 Sathya 28 388460 Yes Referred G6P3A2L3 3 14/09/2015 Bp-200/120 Em.Lscs 14/09/2015 A
16 Susila 24 388653 Yes -- Primi 3 16/09/2015 Bp-180/110 Em.Lscs 16/09/2015 A
17 Jeevajothi 23 388611 Yes Referred G3P2L2 15/09/2015 U/A 4+ 16/09/2015
18 Ranjitha 21 388419 Yes -- Primi 16/09/2015 U/A 4+ 17/09/2015
19 Dhavamani 27 388992 Yes Referred G2P1L0 3 18/09/2015 -- Em.Lap 18/09/2015 A
20 Sundari 21 386704 Yes -- Primi 01/09/2015 Hb-6.8g 19/09/2015
21 Saranya 21 389075 Yes -- Primi 20/09/2015 U/A 3+ 20/09/2015
22 Vimala 26 389227 Yes -- Primi 21/09/2015 U/A 4+ 21/09/2015
23 Shanthini 22 389372 Yes Referred Primi 21/09/2015 U/A 3+ 21/09/2015
24 Renuka 20 389570 Yes -- Primi 23/09/2015 U/A 3+ 23/09/2015
Primi 3 Bp-180/120 Em.Lscs A
25 Subha 23 389606 Yes -- Twins 23/09/2015 U/A 3+ 23/09/2015
26 Vadivukarasi 32 390079 Yes Referred Primi 26/09/2015 U/A 4+ 27/09/2015
27 Sivagami 25 389611 Yes Referred Primi 23/09/2015 U/A 3+ 27/09/2015
28 Kalaivani 30 388691 Yes -- Primi 3 16/09/2015 -- Em.Lscs 28/09/2015 A
3 Em.Lscs A
29 Susila 27 390231 Yes -- G2P1L1 28/09/2015 -- C.Hys 29/09/2015
30 Seethalakshmi 26 390738 Yes -- G4P1L1A2 3 30/09/2015 -- Cys.Hys 01/10/2015 A
31 Renugadevi 30 390914 Yes -- G2P1L1 3 01/10/2015 Hb-5g Em.Lscs 03/10/2015 A
32 Panjalai 26 391028 Yes Referred Primi 01/10/2015 U/A 3+ 03/10/2015
33 Pandiammal 30 391407 Yes Referred G2P1L1 3 04/10/2015 -- Em.Lscs 04/10/2015 A
34 Parimala 25 388396 Yes -- G2P1L1 3 14/09/2015 -- Em.Lscs 15/09/2015 A
3 Bp-160/120 Outside/LN A
35 Muthulakshmi 27 388349 Yes Referred P2L2 14/09/2015 U/A 3+ Delivery --
3 Bp-200/120 LN A
36 Maheshkani 28 390305 Yes -- Primi 28/09/2015 U/A 4+ 06/10/2015 A
37 Deepika 25 386190 Yes -- G2P1L1 3 21/09/2015 Bp-70/ Em.Lap TAH 01/09/2015 D
2 Em.Hysterotom D
38 Thaya 22 386764 Yes -- Primi 02/09/2015 Bp-200/150 y 02/09/2015
39 Anandi 25 388949 No -- G4P2L2A1 1 19/09/2015 -- MVA 19/09/2015 -
3 Em.Rpt.Lscs -
40 Mariyammal 25 381228 Yes -- P2L2 21/09/2015 Hb-3g done outside 21/09/2015
1 Bp-60/ Em.Laperotamy -
41 Praveena 33 390202 No Referred G3P2L2 28/09/2015 PR-180/min 28/09/2015
Month:Septermber
Event caused
1 M 2.6Kg - Severe preeclampsia with abruption HT 3 U pc
4 U ffp
AP Yes - 4 U plt
2 M 2.5 Kg - Type III placenta previa hrg 5 U pc
AP Yes - 4 U ffp
3 M 2.7 Kg - Antepartum eclampsia /atonic HT 5 U pc
AP Yes TAH 4 U plt
4 F 1.83 Kg + Placenta Accreta hrg 4 U pc
4 U ffp
IP Yes TAH 2 U plt
5 F 1.25 Kg + Abruption Grade III with impending coagulatory 2 U pc
AP DIVC Yes - 4 U ffp
6 M 2.2 Kg - Type III placenta previa with bleeding hrg 4 U pc
per veginum 4 U ffp
AP Yes - 2 U plt
7 M 3.2 Kg - AN Imminent eclampsia HT -- - --
8 F 2 Kg - Severe preeclampsia/Intrauterine HT
AN Growth Restriction -- - --
9 M 1.6 Kg + Rupture uterus with bladder rent Uterine 3 U pc
4 U ffp
IP Yes TAH 4 U plt
10 M 3.8 Kg - Placenta Accreta Hrg 4 U pc
4 U ffp
IP Yes Subtotal Hys 2 U plt
11 2.5 Kg - Abruption Grade III with impending coagulatory 2 U pc
F AN DIC Yes - 6 U ffp
12 2.4 Kg - Abruption Grade III HT 2 U pc
F AN Yes - 4 U ffp
13 1.3 Kg + Imminent eclampsia with HT
F AN uncontrolled HT Yes - --
14 2.4 Kg - Abruption Grade III hrg 2 U pc
M AN Yes - 2 U ffp
15 1.3 Kg + Antepartum eclampsia with HT
M AN uncontrolled HT MV - --
16 M 1.4 Kg + AN Imminent eclampsia HT Yes - --
17 F 900g - AN Severe preeclampsia HT -- - --
18 F 1.9 Kg + AN Severe preeclampsia HT -- - --
19 1.035 + Placenta percreta with hrg 4 U pc
Kg hemoperitoneum 6 U ffp
F IP Yes C.Hye 4 U plt
20 1.5 Kg + HELLP syndrome hepatic 2 U pc
10 U ffp
M AP Yes - 4 U plt
22 M 2.6 Kg + AN Severe preeclampsia HT -- - --
23 M 800 g - AN Severe preeclampsia HT -- - --
24 F 2.7 Kg - AN Imminent eclampsia HT -- - --
25 M 1.1 Kg + AN Antepartum eclampsia HT Yes - --
26 F 2.5 Kg - AN Imminent eclampsia HT -- - --
28 2.5 Kg - Type III placenta previa with bleeding hrg 4 U pc
per vaginum 4 U ffp
F AN Yes - 2 U plt
29 3 Kg - central placenta previa with bleeding hrg 4 U pc
F IP per vaginum Yes TAH 4 U ffp
30 2.6 Kg - Placenta accreta hrg 5 U pc
TAH 4 U ffp
F IP Yes Bleeding 6 U plt
31 2.5 Kg - Type III placenta previa with bleeding hrg
M AP per vaginum Yes - 4 U pc
32 M 3.8 Kg - AP Severe preeclampsia HT -- - --
33 4 Kg - atonic postpartum haemorrhage hrg 4 U pc
4 U ffp
F IP Yes TAH 2 U plt
34 M 2 Kg - PP Acute Pulmonary edema MV - --
35 F 2.3 Kg - PN Severe preeclampsia HT -- - --
36 F 1.9 Kg Severe preeclampsia with HT
F 2 Kg AP uncontrolled Hypertension -- - --
37 500g Type III Retro lateral placenta hrg 5 U pc
percreta fundal perforation 10 U ffp
D IP MV TAH 6 U plt
38 D 500g AP Antepartum eclampsia HT -- - --
39 -- Incomplete Abortion/Hypovolemic hrg
- - shock -- - 5 U pc
40 -- Emergency Laparotomy hrg 7 U pc
12 U ffp
- - -- Lap 8 U plt
41 - -- - Ruptured ectopic Hypovolemic shock Hrg -- - 4 U pc
Month: October
S.No Name Age IP No B

Referral OBS GA DOA Vitals / Inv Mode of Time of Alive/
1 Sundari 31 391702 Yes Referred G3P2L2 3 06/10/2015 Bp-190/110 Em.Lscs 07/10/2015 A
3 Bp-200/110 D
2 Ilavarasi 29 392097 Yes Referred G2P1L1 08/10/2015 3+ Em.Lscs 09/10/2015
3 Em.Lscs A
3 Revathi 30 391316 Yes -- G3P2L1 10/10/2015 -- C.Hys 10/10/2015
4 Francis mary 28 392594 Yes -- G2P1L1 3 12/10/2015 Bp-180/120 Em.Lscs 12/10/2015 A
3 Bp-170/110 A
5 Sathya 29 392709 Yes Referred Primi 12/10/2015 4+ Em.Lscs 14/10/2015
3 Em.Lscs A
6 Anudevi 25 390929 Yes -- G3P1L1A1 01/10/2015 -- C.Hys 15/10/2015
7 Rajakumari 30 393141 Yes -- G4P2L2A1 3 15/10/2015 -- Em.Lscs 16/10/2015 A
8 Jothi 19 393274 Yes Referred Primi 3 16/10/2015 -- Em.Lscs 16/10/2015 A
9 Ragini 28 393252 Yes -- Primi 3 16/10/2015 Bp 200/120 Em.Lscs 16/10/2015 A
10 Latha 32 392543 Yes -- G3P1L1A1 3 11/10/2015 -- Em.Cy.Hys 16/10/2015 A
11 Saranya 25 392776 Yes -- G5P2L1A2 3 13/10/2015 Hb-6g Em.Lscs 17/10/2015 A
12 Karthiga 24 393335 Yes -- Primi 3 17/10/2015 Hb-6g Em.Lscs 17/10/2015 A
13 Devi 26 393254 Yes -- G2P1L1 3 16/10/2015 Bp-190/120 Em.Lscs 17/10/2015 A
14 Amudha 30 393471 Yes -- G3P2L1A1 3 18/10/2015 Bp-180/120 Em.Lscs 18/10/2015 A
15 Amala Mary 22 392941 Yes -- G2P1L1 3 14/10/2015 Hb-7g Em.Lscs 19/10/2015 A
16 Selvi 28 394045 Yes -- -- 3 22/10/2015 -- Em.Lap 22/10/2015 A
1 Bp-70/ Em.Lap A
17 Vasantha 23 392605 No -- Primi 12/10/2015 Hb-4g partial sal 12/10/2015
P1L1 3 manual removal A
Severe pallor+++ of plac
18 Vijayalakshmi 21 393000 Yes Referred anemia 15/10/2015 Hb-3g 15/10/2015
2 pallor+++ Em.Hys A
19 Kanchana 23 393064 Yes Referred G2P1L1 15/10/2015 Hb-5g 15/10/2015
G2P1L1 2 pallor+++ Em.Hys D
20 Nithyakala 28 393121 No -- 17wks 15/10/2015 Hb-6g 17/10/2015
21 Valarmathy 23 394421 Yes Referred P1L1 3 -- Bp-180/110 LN outside -- D
22 Banupriya 25 405112 Yes Referred Primi 3 27/10/2015 Bp-170/120 Em.Lscs 27/10/2015 A
23 Maheswari 27 405100 Yes Referred P1L1 3 27/10/2015 Bp-150/110 Lscs outside -- A
Month:October
Event caused
1 F 4 Kg - AP Imminent eclampsia HT - - -
2 F 1.3 Kg + Imminent /Diabetes Mellitus HT
AP eclampsia - - -
3 M 1.9 Kg + Previous two LSCS/Central placenta hrg 5 U pc
previa 4 U ffp
IP Yes TAH 6 U plt
4 F 2.8 Kg - Previous Lscs/Abruption GR-2 hrg 4 U pc
6 U ffp
IP - - 2 U plt
5 F 1.3 Kg + AP Severe preeclampsia HT - - -
6 F 3 Kg - Central Placenta Previa with atonic hrg 4 U pc
PPH 4 U ffp
IP Yes TAH 2 U plt
7 M 2.6 Kg - Antepartum eclampsia with acute HT
AP pulmonary edema Yes - -
8 F 1.8 Kg + Abruption/Impending DIVC coagulatory 2 U pc
IP Yes - 6 U ffp
9 F 2 Kg -- AP Antepartum eclampsia HT MV - -
10 M 1.6 Kg + Placenta accreta hrg 4 U pc
4 U ffp
IP Yes - 2 U plt
11 2.6 Kg - central placenta previa with bleeding hrg 5 U pc
per vaginum 4 U ffp
F IP Yes - 6 U plt
12 3.3 Kg - central placenta previa with bleeding hrg 4 U pc
per vaginum 2 U ffp
F IP Yes - 4 U plt
13 M 1.8 Kg + AP Imminent eclampsia HT - - 1 U pc
14 1.2 Kg + Impending DIVC with imminent coagulatory
2 U pc
eclampsia
M AP Yes - 4 U ffp
15 2.9 Kg - central placenta previa with bleeding Hrg 5 U pc
per vaginum 4 U ffp
M AP - - 2 U plt
16 3 Kg - atonic postpartum haemorrhage hrg 8 U pc
16 U ffp
M PP Yes TAH 12 U plt
17 - - Ruptured R ampullary ectopic with hrg
- - Hypovolemic shock Yes - 3 U pc
18 - - Outside delivery with retained hrg 5 U pc
placenta 4 U ffp
M IP Yes - 4 U plt
19 950g - Abruption Grade III with Impending coagulatory 3 U pc
F IP DIVC Yes - 10 U ffp
20 150g - Ruptured uterus uterine 7 U pc
16 U ffp
- IP Yes TAH 10 U plt
21 2.3kg - postpartum Imminent eclampsia HT
M PP - - -
22 2 Kg - Antepartum eclampsia HT
M AP Yes - -
23 3kg - Seizure disorder/postpartum HT
F AP eclampsia Yes - -
Month: November

Bp-90/60
PR-140
RR-28
SPO2-96%
G2P1L1 Echo-Mod
1 Maruthaiyammal 32 397732 Yes Referred 11/11/2015 Em.Rpt.Lscs 11/11/2015 A
Prev Lscs severe MR
milt
3 MS/AF/PHT
MVO-1.3
cm2
RR-24
2 Saraladevi 27 398473 Yes Referred P2L2 3 18/11/2015 18/11/2015 A
SPO2-70%
P1L1
RR-32
3 Sathya 24 396486 Yes Referred fetal 3 05/11/2015 -- 05/11/2015 A
SPO2-60%
distress
RR-28 Rent Closure
4 Jothi Nirmala 24 396810 Yes Referred P2L2 3 07/11/2015 09/11/2015 A
SPO2-72% outside
Bp-110/60
PR-126
LN
5 Chitra 20 396984 Yes Referred Primi 3 09/11/2015 RR-30 30/11/2015 A
episiotomy
SPO2-90%
Hb-4.6g
Bp-110/70
PR-120
6 Sudha devi 35 396549 Yes Referred G2P1L0 3 05/11/2015 Em.Rpt.Lscs -- D
RR-24
SPO2-98%
Bp-110/70
PR-120
7 Anjalai 28 396664 Yes Referred G3P2L1 3 05/11/2015 Em.Rpt.Lscs 06/11/2015 A
RR-24
SPO2-98%
Bp-100/60
PR-78
8 Saranya 24 396741 Yes Referred G2P1L1 3 06/11/2015 Em.Rpt.Lscs 06/11/2015 A
RR-12
SPO2-99%
Bp-110/60
PR-80 Em.Hysterect
9 Meera 37 394847 Yes -- G2P1L1 3 24/11/2015 -- A
RR-14 omy
SPO2-99%
Bp-100/70
PR-136
10 Neelavathi 37 402489 Yes Referred G5P2L2A2 3 25/12/2015 -- 27/11/16 D
RR-30
SPO2-99%
11 Sasikala 28 396278 Yes Referred Primi 3 03/11/2015 Bp-180/110 LN epi 5/11/16 A
Bp-180/110
PR-82
12 Rahamath Nisha 40 399741 Yes Referred G2P2L2 3 27/11/2015 Em.Lscs 27/11/16 D
RR-18
SPO2-99%
Bp-200/120
PR-76
13 Thenmozhi 26 396241 Yes Referred G2P1L1 3 03/11/2015 LN.epi 6/11/16 A
RR-16
SPO2-98%
PR-120
14 Mahalakshmi 29 397600 No -- G3P2L2 1 09/11/2015 SPO2-88% MVA 9/11/16 A
Hb-4.8g
Bp-80/50
PR-114 Digital
15 Kalavathi 22 397889 Yes Referred G4P3L2 1 11/11/2015 11/11/16 A
SPO2-99% Evaluation
Hb-6g
Bp-100/60
16 Vanitha 24 401112 Yes -- Primi 3 19/11/2015 PR-98 Em.Lscs 23/11/16 A
Hb-4.5g
Emergecy
17 priyadharshini 23 396249 no - Primi - 03/11/2015 Hb-4.1g 03/11/2015 A
laparotomy
manual
18 zahira banu 28 397054 - P2L1A1 3 09/11/2015 Hb-5.3g removal of 09/11/2015 A
placenta
Emergency
19 kamala 27 397157 - Primi 2 09/11/2015 BP-180/120 10/11/2015 D
hysterotomy
20 Gandhimathi 42 398154 - G5P2L2A2 1 17/11/2015 Hb-3.9 g MVA 17/11/2015 -
Emergency
21 gomathi 25 399130 - Primi 2 30/11/2015 CT->10min 30/11/2015 D
hysterotomy
Emergency
22 vinitha 22 391010 Referred Primi 3 08/11/2015 BP-200/130 08/11/2015 A
LSCS
Emergency
23 janci vindhiya 23 396101 Referred Primi 3 30/10/2015 BP-180/110 30/10/2015 A
LSCS
Ceasarean
24 Eswari 25 396451 Referred G4P3L1 3 05/11/2015 Hb-4.6g 05/11/2015 A
hysterectom
25 Anbarasi 23 396459 Referred P1L1 3 -- 160/110 LSCS outside -- A
26 Anjammal 35 397451 Referred P3L3 3 10/11/2015 HB-3.4g LN 10/11/2015 A

Emergency
27 Ilayarani 22 397608 - Primi 3 13/11/2015 200/120 13/11/2015 A
LSCS
Emergency
28 Lakshmi 23 398112 Referred Primi 3 19/11/2015 plt-30000 19/11/2015 A
LSCS
Emergency
29 Pothumponnu 20 399214 - Primi 3 24/11/2015 - 24/11/2015 D
LSCS
Month:November
Event caused
1 F 2.5 Kg - pulmonary edema CVS
yes -
2 F 2.5 Kg - -
3 - - - -
4 - - - Rupture uterus uterine 5 U pc
10 U ffp
IP yes - 6 U plt
5 F 1.8 Kg + Anemic CCF CVS
AN yes -
6 M - - Rupture uterus uterine
Em.Laparotomy
IP yes Rent closure
7 M 2.3 Kg + Placenta accreta hrg
IP yes
8 M 2.5 Kg + HELLP syndrome hepatic
AN yes --
9 M 1.6 Kg + Placenta accreta hrg
yes -
10 M 700g - Rupture uterus uteine Yes Em.Lap TAH 6 U pc
5 U ffp
- 3 U plt
11 2.4 + Severe preeclampsia HT
F AP - - 1 U pc
12 2.5 - HELLP /AKI Renal 7 U pc
11 U ffp
F IP Yes - 6 U plt
13 2.2 + Acute pulmonary edema HT
M AP CPAP - 2 U pc
14 - Hypovolemic shock hrg
- - - - 5 U pc
15 - sepsis/AKI recovered sepsis
- - Yes - 3 U pc
16 M 1.8 + - DIC/AKI Coagulatory Yes - 6 U pc
10 U ffp
6 U plt
17 - - ruptured ectopic with hrg 5U pc
hemoperitoneum 10U FFP
- - 6U Plt
18 3kg - retained placenta hrg 5U pc
10U FFP
M pp yes + 10U Plt
19 F 300g - AP AP eclampsia HT yes -
20 - - incomplete abortion hrg 3U PC
21 400g - AP eclampsia/uncontrolled BP/DIC HT 2U pc
6U FFP
M AP yes
22 - AP AP eclampsia HT yes -
23 F 2.2kg - AP AP eclampsia HT yes
24 - Atonic PPH hrg 5U pc
12U FFP
M PP yes + 8U Plt
25 2.5kg - PP PP eclampsia HT yes -
26 F 2.7kg - AP severe anemia Others yes 6-U
27 F 2.1kg + IP IP eclampsia HT yes -
28 M 3kg - AP Gestational thrombocytopenia Coagulatory plt-10U
29 F 2.3kg - AP Abruption gr-3 coagulatory -
Month: December
1 MVA Attempt A
1 Geetha 29 400112 No Referred G3P2L2 19/12/2015 Hb-4.6g outside 20/12/2015
3 Bp-140/90 A
Hb-4.3g
increased
2 Easwari 23 403418 Yes -- P1L1 31/12/2015 enzymes Lscs outside 30/12/2015
1 MVA A
3 Muthulakshmi 35 399855 No -- G2P1L1 28/12/2015 -- Em.Lap 06/12/2015
1 Em.Lap A
4 Malathi 29 401547 Yes -- G3P2L1 18/12/2015 Hb-5g TAH 19/12/2015
5 Mahalakshmi 31 401689 Yes Referred G2P1L1 3 19/12/2015 Bp-180/110 Em.Rpt.Lscs 20/12/2015 D
6 Maheswari 21 400384 Yes -- G2P1L1 3 10/12/2015 Bp-200/120 Em.Lscs 10/12/2015 A
7 Rajeswari 22 400537 Yes -- G2P1L0 3 12/12/2015 Bp-160/120 Em.Lscs 12/12/2015 D
8 Kokila 22 400169 Yes -- G2P1L1 3 13/12/2015 Bp-180/120 Em.Lscs 13/12/2015 A
9 Vennila devi 22 400526 Yes -- G2P1L1 3 15/12/2015 Bp-200/110 Em.Lscs 15/12/2015 D
3 Bp-70/50 A
10 Sasikala 22 402081 Yes Referred G2P1L0 21/12/2015 PR-150/min Em.Lap 21/12/2015
3 Post Lscs A
11 Sameera banu 25 422497 Yes -- P1L2 08/12/2015 Bp-160/120 outside --
3 Em.Lscs A
12 Nilavathy 37 402489 Yes -- Primi 08/12/2015 Hb-5g TAH 08/12/2015
13 Kanmani 24 404321 Yes Referred G2P1L1 3 05/12/2015 Hb-6g LN epi 07/12/2015 A
14 Kowsalya 25 400997 Yes -- G2P1L1 3 26/12/2015 spo2-89% Outlet forceps 06/12/2015 D
15 Mary 23 400026 Yes Referred Primi 3 04/12/2015 Bp-180/120 Em.Lscs 04/12/2015 A
16 Vetriselvi 23 402832 Yes -- P1L1 3 01/12/2015 Bp-200/120 Em.Lscs 01/12/2015 D
17 Vadivu 29 402512 Yes -- G4P3L3 1 24/12/2015 Hb-4.2g MVA Done 24/12/2015 A
18 Rani 25 402482 Yes -- G2A1 3 24/12/2015 Bp-180/110 LN Epi 26/12/2015 A
1 Temp-102F MVA done A
vaginal digital
swap-Ecoli evacuation
19 Saraswathi 29 402521 Yes Referred G3P2L2 25/12/2015 --
Month:December
Event caused
1 - - - Caesarean scar pregnancy with hrg 4 U pc
- bleeding per vaginum Yes + 6 U ffp
2 - - - HELLP hepatic 2 U pc
PP Yes - 6 U ffp
3 - - - subtotal hystrotony with Rectal others
perforation closure with sigmoid
- colostomy Yes + --
4 - - - Caesarean scar pregnancy hrg 5 U pc
10 U ffp
- Yes + 6 U plt
5 F 0.9 Kg - AP Imminent eclampsia HT Yes - --
6 F 2.4 Kg - Antepartum eclampsia HT 3 U pc
AP Yes - 6 U ffp
7 M 1.8 Kg - Abruption Grade III Coagulatory 4PC
IP Yes - 6FFP
8 F 2.2 Kg + AP Antepartum eclampsia HT Yes - --
9 F 1.2 Kg - AP Antepartum eclampsia HT Yes - --
10 - - - - Rupture uterus HT Yes - --
11 - - - PP postpartum eclampsia HT No - --
12 2.2 Kg - Abruption Grade III with atonic hrg 5 U pc
F IP No + 10 U plt
13 2 Kg - Jaundice complicating pregnancy Hepatic 2 U pc
M AP No - 12 U ffp
14 2.75 Kg - RHD/Severe MS/MR/acute CVS
M IP pulmonary edema CPAP - 1 U pc
15 1.8 Kg + Abruption Grade III Coagulatory 2 U pc
F IP No - 4 U ffp
16 M 2.5 Kg - AP Antepartum eclampsia HT No - --
17 - - - - Incomplete abortion hrg No - 5 U pc
18 F 2.1 Kg + AP Severe preeclampsia HT No - 1 U pc
19 - - - - Septic abortion Sepis No - 2 U plt
Maternal Death
1 Altered -- --
Admin sensorium
in Na-120
01 Tahira Banu 27 TMCH Yes -- Primi 27/09/15 RBS 260 --
3 SPO2-90% LN D
02 Sophia 28 390342 Yes Referred Primi 28/09/15 Hb – 3.8g 28/09/15
03 Ramani 30 389119 Yes Referred G3P2L1 3 20/09/15 Bp-180/140 Em.R.Lscs 20/09/15 D
3 On LN with epi -
admission
Normal
SPO2-65%
PR-
04 Revathy 22 389441 Yes -- Primi 22/09/15 140/min 28/09/15
3 >12 of Em.Lscs A
admission
05 Poonguzhali 25 391015 Yes Referred Primi 01/10/15 PR-138 05/10/15
PR-
120/min
Increasing
PT
Cola color
06 Amutha 32 393471 Yes Referred G3P1L1A1 18/10/15 plt 41000 18/10/15
3 Hb – 48% LN with Epi A
PR-
138/min
subcut
07 Arivazhagi 25 392665 Yes -- G2P1L1 12/10/15 emphysema 13/10/15
3 PR- LN A
140/min
08 Soundharavalli 36 394087 Yes -- P4L4A1 22/10/15 SPO2-70% 25/10/15
09 Sathya 27 3966828 Yes Referred P1L1 3 05/11/15 Hb- Em.Lscs 05/11/15 -
180/min outside
Non bund
PR-?
Bp-?
SPO2-60%
3 icterus LN with EPI D
Bp-4g IUD
10 Kamatchi 22 399363 Yes Referred G2P1L1 30/11/15 plat-13x103 04/12/15
P2L2 3 Bp-90/50 Outside -
11 Dhanalakshmi 22 401190 Yes Referred PND -36 16/12/15 Hb-3g 10/11/15
3 PR- Em.Rpt.Lscs D
119/min
Increasing
Jeenath RFT 88/17
12 Begam 28 401450 Yes Referred G4P2L2A1 18/12/15 Bp-7g 18/12/15
3 PR- Em.Lscs D
119/min
decreasing
13 Umadevi 37 405208 Yes Referred Primi 16/01/16 28000 plt 16/01/16
3 BP-150/90 Outside post -
PR- CPR status
110/min
RR-26
Na – 12g
14 Sathya 20 406605 Yes Referred P1L1 27/01/16 K-4.2 27/01/16
15 Rani 22 407039 Yes -- Primi 3 30/01/16 LN 08/02/16 -
16 Mariyammal 23 408119 Yes Referred P3L3 3 10/02/16 Infected LN outside 01/02/16 A
1 BP-80/50 -- --
PR-
150/min
17 Andal 24 409580 No Referred P2L2A1 21/02/16 RR-50/min 21/02/16
1 Bb-80/50 -- --
94%
pallor+++
18 Saraswathi 40 413758 No Referred G5P4L4 22/03/16 Hb-4.2g 22/02/16
1 PR- Home delivery --
146/min
95% with
O2
28/min
19 Vasuki 20 413888 No Referred P1L0 23/03/16 Hb-3.6g 23/03/16
3 PR- LN A
130/min
Bp-80/50
20 Megala 30 415057 Yes Referred G4P3L3 31/03/16 Hb-9g 01/04/16
3 PR- LN with epi A
140/min outside
Bp-?
21 Sumathy 20 418010 Yes Referred P1L1 24/04/16 Hb-4g --
1 Bp-60/? - --
PR-
146/min
22 Rosemary 26 419480 Yes Referred Primi 18/04/16 Hb-5.2g 16/04/16
3 Bp-200/120 LN D
U-98
23 Valarmathy 26 418311 Yes Referred Primi 26/04/16 C-32 26/04/16
3 Lcteric LN with epi A
Hb-5.6g
24 Tamil ilakkiya 21 419806 Yes -- Primi 07/05/16 Bp-11.8g 09/05/16
1 HR- Em.Laparotomy --
150/min
RR-26/min
SPO2-86%
with O2
sr..Bhces
25 Kanimozhi 25 421949 No Referred Primi 23/05/16 138224 25/05/16
2 Normal spontaneous D
Bp,PR expulsion
G4P1L1A2 JVP
260429 Previous increasing
26 Revathy 30 (TMCH) No -- Lscs 27/05/16 SPO2-96% 31/05/16
1 Electrolyte Em. --
PR- Laparotomy
148/min
RR-26/min
Bp-?
Vag swap
27 Dhanalakshmi 42 424313 No Referred P2L2A1 07/06/16 Ecoli 07/06/16
3 LN outside A
28 Mangalam 28 428829 Yes Referred P3L2 23/06/16 - 13/06/16
36542 2 Spontaneous D
29 Priya 22 (TMCH) No Referred G4P3L3 15/07/16 SPO2-60% expulsion 22/07/16
Maternal Death
S. Sex Weight NICU Timing Type of Event Organ ICU Surgic Blood DOD Hosp. Cause of
No of Dysfunction al Stay Death
Event interve
ntion
1 -- -- - Type I diabetesmellitus/ RS 27/09/15 -- Respiratory
Metabolic encephalopathy failure
sudden cardiac
AN -- - -- arrest
2 M 2.5 Kg - Severe Anemia /AGE SEPSIS 30/09/15 2 AGE sepsis/
Acute pulm
7U pc edema
12 U ffp
PP -- - 10 U plt
3 F 800 g - Antepartum eclampsia CNS Refer 22/09/15 2 HIE/Stroke/Re
to spiratory
TMC failure
AP H - --
4 -- -- - Trival MR CVS 28/09/15 6 Pulmonary
IP -- - -- embolism
5 F 1.5 Kg + Rheumatic heart disease – CVS 05/10/15 4 cardiac
MS/MR congestive CPAP failure/shock
AP cardiac failure MV - --
6 M 1.2 Kg + Imminent eclampsia, HEPATIC 29/10/15 11 Imm
HELLP 8 U pc eclampsia/DIC
6 U ffp /
PP MV TAH 11 U plt CVA/HIE
7 M 2.75 Kg - Severe anemia, HRG 14/10/15 2 Acute pulm
Atonic postpartum 6 U pc edema/pneumo
haemorrhage 10 U ffp thorax
IP MV - 10 U plt
8 F 2.2 Kg - PT Sequelae RS 26/10/15 4 COR
Pulmonale/Res
p failure
PN MV - -
9 -- -- - Massive Pulmonary edema RS 05/11/15 - Spinal
shock/HIE/DI
IP MV - - C
10 2.5 Kg - HELLP HEPATIC 7 U pc 10/12/15 10 MODS
10 U ffp
F AP MV - 10 U plt
11 -- - severe anemia with failure CVS 2 U pc + 11/12/15 5 CCF/Hyper
2 U pc thyroidism
-- PP MV - PN wd
12 1.3 Kg + HELLP/HRS HEPATIC 23/12/15 5 HEP-
8U pc ENCEPHALO
13U ffp PATHY
F AP MV - 8 U plt MODS
13 1.3 Kg + HELLP/MODS/NVP +ve HEPATIC 2 U pc 23/01/16 7 MODS
F AP MV - 4 U plt
14 -- -- - AP status epilepticus CNS MV - 3 U ffp 31/01/16 4 HIE
15 -- - RHD-MS,Post Mitral CVS 22/02/16 22 Severe pulm
Valve HT
-- PP stenosis -- - --
16 2.4 Kg - RHD-Severe Mitral CVS 11/02/16 1 Acute pulm
Stenosis edema /
SVT /
Cardiogenic
M AP -- - -- shock
17 -- - Septic abortion SEPSIS 3 U pc 01/03/16 10 Septic shock /
-- IP MV - 6 U ffp ARF
18 -- - Septic abortion Grade – SEPSIS 22/03/16 - Septic shock /
III 6 U pc DIC
4 U ffp
-- -- -- - 8 U plt
19 -- - severe anemia, septic SEPSIS 23/03/16 - Septic Shock /
shock Pulm edema
-- -- -- TAH 1 U pc
20 3 Kg + AFE/DIC COAGULATO 2 U pc 23/03/16 2 DIC /
RY 10 U ffp Am.Fluid
M AP MV - 8 U plt Embolism
21 2.8 Kg - Traumatic PPH HRG 6 U pc 20/04/16 4 Irreversible
18 U ffp shock /
F IP MV - 12 U plt DIC / AKI
22 -- - Post MTP/sepsis SEPSIS 5 U pc 27/04/16 1 AKI / Septic
10 U ffp shock /
-- -- -- - 6 U plt DIC / HIE
23 1.2 Kg + Severe preeclampsia COAGULATO 6 U pc 27/04/16 1 DIC / AKI
RY 16 U ffp
M -- -- - 10 U plt
24 2.7 Kg - Acute hepatic HEPATIC 13/04/16 6 Acute fatty
coagulopathy HIE 6 U pc liver of
38 U ffp pregnancy /
F AP -- - 10 U plt HIE / AKI
25 -- - choriocarcinoma with HRG 7 U pc 24/05/16 1 Irreversible
bleeding per vaginum 10 U ffp Hrg shock
-- -- MV TAH 7 U plt
26 500 Kg - RHD,MS pulmonary CVS 01/06/16 3 AF / CCF / VT
edema/ AKI/cardiorenal / AKI
M -- syndrome MV - --
27 -- - Rectal injuiry/sigmoid SEPSIS 15/06/16 8 Septic abortion
-- -- colon colostomy MV TAH 5 U pc Grade IV
28 -- - R parietotemporal massive CNS 26/06/16 13 Massive MCA
hemorrhage/ infarct with infarct
edema with L hemiparasis with cardio
respiratory
- - Yes - 1 U pc arrest
29 -- -- RHD-MS/Double valve CVS 22/06/16 7 cardio
Replacement done/L respiratory
parietooccipited arrest
hemorrhage/RSF/Cardiac
-- AP failure Yes -- --

Lakshmi

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DISSERTATION ON

A PROSPECTIVE STUDY OF MATERNAL NEAR MISS AND

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

In partial fulfillment of the regulations

M.S. OBSTETRICS AND GYNAECOLOGY

THANJAVUR MEDICAL COLLEGE,

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

This is to certify that this dissertation entitled “A PROSPECTIVE

STUDY OF MATERNAL NEAR MISS AND MATERNAL MORTALITY IN

A TERTIARY CARE CENTER WITH SPECIAL REFERENCE TO ITS

ETIOLOGY AND MANAGEMENT” is a bonafide original work of

Dr.LAKSHMI S. in partial fulfillment of the requirements for M.S Branch -

VI (Obstetrics & Gynaecology) Examination of the Tamilnadu Dr.M.G.R.

August 2015 to July - 2016.

Prof.Dr.M.VANITHAMANI, M.S., MCh.,, Prof. DR. S.PRADEEBA M.D., OG

Certified that the thesis entitled “A PROSPECTIVE STUDY OF

MATERNAL NEAR MISS AND MATERNAL MORTALITY IN A

TERTIARY CARE CENTER WITH SPECIAL REFERENCE TO ITS

ETIOLOGY AND MANAGEMENT” has been carried out by

Dr.LAKSHMI S, under my direct supervision and guidance. All the

have been checked by me periodically.

Place: Thanjavur Prof.Dr.R.RAJARAJESWARI.M.D,D.G.O.,DNB.,

T he f irst page of your submissions is displayed below.

Submission author: 221316202 Ms Og dr.lakshmi.s

Co pyright 20 16 Turnitin. All rights reserved.

I, Dr.LAKSHMI S., solemnly declare that dissertation titled “A

PROSPECTIVE STUDY OF MATERNAL NEAR MISS AND MATERNAL

MORTALITY IN A TERTIARY CARE CENTER WITH SPECIAL

REFERENCE TO ITS ETIOLOGY AND MANAGEMENT” is a bonafide

work done by me at Thanjavur Medical College, Thanjavur during

September 2015 to August 2016 under the guidance and supervision of

Prof.Dr.S.PRADEEBA, M.D.,OG., Head of the Department, Department of

Obstetrics and Gynaecology, Thanjavur Medical College, Thanjavur.

This dissertation is submitted to Tamilnadu Dr. M.G.R Medical

University towards partial fulfillment of requirement for the award of

M.S Degree (Branch -VI) in Obstetrics and Gynaecology.

I gratefully acknowledge and express my sincere thanks to

Prof.Dr,M.VANITHAMANI M.S., MCh Dean, Thanjavur Medical College and

hospital, Thanjavur for allowing me to do this dissertation and utilizing the

I am extremely grateful to Prof Dr. S.PRADEEBA, M.D.,OG., Professor

and Head of the Department, Dept of Obstetrics and Gynaecology, Thanjavur

I would like to express my gratitude to my guide

Prof. Dr.R.Rajarajeswari, M.D.,D.G.O.,D.N.B., for her full-fledged support,

I would also like to thank Prof Dr.E.KALARANI, M.D.,D.G.O., formerly

I would like to express my gratitude to my respected Professor

Dr.M.Poovathi M.D., D.G.O., for their guidance and constructive criticism in

I would also like to extend my warmest gratitude to my coguide

Dr.Sudha.M.D, Assistant professor, Department of Obstetrics and Gynaecology

for her constant encouragement and support.

helped me complete this study.

A special thanks to all the patients who willingly co-operated and

participated in this study.

constant source of encouragement to me.

I would like to express my most sincere gratitude to my family for their

constant support and tolerance.

4. MATERIALS AND METHODS 46

5. RESULTS AND OBSERVATIONS 50

“Maternal mortality ratio is one of the health indicator used to

base to the ice berg maternal morbidity which remains undescribed. To

challenge this problem, maternal near miss can be used as a

compliment to maternal death as a maternal health indicator”.

Maternal near miss is defined as “ pregnant or recently delivered

woman who survived a complication during pregnancy, childbirth or 42