Maternal Morbidity Statistics

1. STATISTICSON MATERNAL
MORBIDITY
(MONTH OF AUG 2023)
Presented by
DrAnamJamil
DrSanaKhan

2. DEFINITION
WHO has defined maternal morbidity as “any
health condition attributed to and/or
complicating pregnancy, and childbirth that has a
negative impact on the woman’s well-being
and/or functioning”.

3. MATERNAL
NEAR MISS/
SEVERE
MATERNAL
MORBIDITY(S
MM)
 When a woman nearly dies, but survives a complication
during pregnancy, childbirth or within 42 days of
termination of pregnancy
 WHO identifies a maternal near miss using the signs of
organ dysfunction that follow life threatening
conditions.

4. OBJECTIVES:
 TO DETERMINE THE FREQUENCY OF OVERALL MATERNAL MORBIDITY CASES PRESENTING
IN WARD 8
 TO DETERMINE THE FREQUENCY OF MATERNAL MORBIDITY OCCURING IN WARD 8
 TO DETERMINE THE FREQUENCY OF MATERNAL NEARMISS CASES PRESENTING
IN/ REFFERED TO WARD 8 FROM OTHER HOSPITALS.
 TO DETERMINE THE MATERNAL OUTCOME .

5. MONTH OF AUG 2023
 Total Pts seen = 5163
 OPD - 3703
 ER - 1460
 Total no of admissions = 911
 OUT OF WHICH OBS ADMISSION 823
 GYNAE ADMISSIONS 88
 Total no of deliveries = 575 ( 69.8 % OF OBS ADMISSION )
 Total no of Patients with Maternal Morbidity = 256 (28.1 %)
A) JPMC = 76 Cases (29.6 %)
B) From outside JPMC = 180 (70.4 %)

6. CONTINUED
 Frequency of maternal morbidity in our ward
during the month of AUGUST = 29.6 %

7. CASES
WITH MATERNAL
MORBIDITY(n= 256)
HYPERTENSIVE
DISORDERS
65 (25.4%) UNBOOKED 48 BOOKED 17
ANTEPARTUM
ECLAMPSIA
13 13 -
INTRAPARTUM 1 1
POSTPARTUM
ECLAMPSIA
9 9 -
SEVERE PRE
ECLAMPSIA
23 15 8
HELLP SYNDROME 19 10 9

8. CONTINUED
POST DELIVERY STATUS
 Shifted to ward 8 and discharged = 53 (81.5 %)
 Shifted outside JPMC= 1
 Shifted within JPMC= 11
 RETURNED BACK= 9
 1 Pt with antepartum eclampsia expired in surgical ICU
 1 Pt with HELLP and ITP shifted to chest ICU.
 1 Pt with postpartum eclampsia discharged from QIH

9. ANTE-PARTUM
HEMORRHAGE =
40 (15.6 %)
ANTEPARTUM
HEMORRHAGE
15.6 %
n= 40 UNBOOKED BOOKED
PLACENTA
PREVIA
18 (45 %) 10 8
PLACENTAL
ABRUPTION
22 (55 %) 16 6

10. MODE OF
DELIVERY:
MODE OF DELIVERY:
n: 40
SVD: 18 (45 %) EM-LSCS:22 (55 %)
PLACENTA PREVIA:
18
4 ( MARGINAL PREVIA) 14
PLACENTAL
ABRUPTION:22
14 8

11. OUTCOME:
a)Shifted to ward 8 and discharged = 39 (97.5 %)
b)Shifted outside JPMC= NIL
c)Shifted within JPMC= Nil
MORTALITY= Nil
1 patients with placental abruption developed AKI post delivery and shifted to Nephrology for
Dialysis

12. POST-PARTUM
HEMORRHAGE N = 24 (9.3 %)
PRIMARY = 14 (58.3%)
SECONDARY= 10 (41.6%)
N= 24 DELIVERED IN JPMC DELIVERED OUTSIDE
JPMC
PRIMARY PPH: 14
(58.3 %)
4 10
SECONDARY PPH: 10
(41.6%)
Nil 10
MODE OF DELIVERY SVD EM-LSCS
PRIMARY PPH: 3 (IN WARD 8)
10 (REFFERED)
1 (IN WARD 8)
SECONDARY PPH: 8 2

13. OUTCOME
OUTCOME
• Shifted to ward 8 and discharged = 21 ( 87.5 %)
• Shifted outside JPMC= 1
• Shifted within JPMC= 2
• Returned back: 2

14. PUERPERAL SEPSIS = 11 (4.2 %)
 Ward 8 = 1 ( Post c section=1)
 Outside jpmc = 10 ( Post c section : 2, home deliveries: 4, delivery at private
hospital :4)

15. OUTCOME:
a)Shifted to ward 8= 8 ( treated and discharged )
b)Shifted outside JPMC = 1 (Expired)
c)Shifted within JPMC= 2 (both returned back)
d)1 Pt shifted to NICVD with impression of left ventricular heart failure

16. INFECTED
WOUND :
14 (5.4 %)
INFECTED
WOUND : 14
(5.4%)
WARD 08:
10
OUTSIDE
JPMC:4
C/SECTION 7 4
INFECTED
EPISIOTOMY
1 -
LAPROTOMY 2 -

17. MORBIDLY
ADHERENT
PLACENTA: 8
(3.1%)
 CASES WITH MAP: 8
 SHIFTED TO WARD AFTER SURGERY AND
DISCHARGED = 3
 SHIFTED OUTSIDE JPMC = NIL
 SHIFTED WITHIN JPMC = 5 ( RETURNED AND DISCHARGED )

18. Case of
Ruptured
Uterus= 7
( 2.7)
BOOKED= 2
UNBOOKED= 5
Repaired 6
Obs hysterectomy
1 case (CASE OF
PLACENTA
PERCRETA)
Patient shifted
outside JPMC: NIL
Shifted within
JPMC 1
Returned back 1

19. N: 24
AFTER LAPROTOMY:
 SHIFTED OUTSIDE : NIL
 WITH IN JPMC : NIL
 MORTALITY= =NIL
 All pts shifted to ward and discharged
ECTOPIC PREGNANCY: 15 (5.8 %)

20. CASES WITH SEVERE ANEMIA – 68 (26.56%)
(hb below 7 gm/dl without APH)
UNBOOKED= 52
BOOKED/REGISTERED = 16 CASES( ADMITTED VIA OPD)
1 Pt with HMB having severe anemia was adm via ER; shifted to
Medical ICU and Expired
1 Pt with HMB having severe anemia and diagnosed case of cardiac
disease adm via OPD shifted to Surgical ICU from where pt shifted to
NICVD
All other patients were managed and Anemia corrected.

21. SOME OTHER CASES WITH MATERNAL MORBIDITY….
4 CASES (1.5 %)
 Cases of Intraperitoneal bleed = 2
 Ward-8 = 1
 Outside JPMC = 1
 Shifted outside JPMC = 1 (QIH)
 Shifted within JPMC = 1 (expired)

22. SOME OTHER CASES WITH MATERNAL MORBIDITY….
4 CASES (1.5 %)
 Cases of Scar Dehiscence = 2
 Shifted to ward = 1
 Shifted outside JPMC = 1 (Kamal Hospital; stable and discharged)

23. OVERALL
MORBIDITY
CASES: 256
HYPERTENSIVE DISORDERS = 65 ( 25.39 % )
ANTEPARTUM HEMORRHAGE = 40 (15.6 % )
POSTPARTUM HEMORRRHAGE= 24 (9.3 %)
SEVEREANEMIA= 68(26.56 %)
MORBID ADHERENT PLACENTA= 8 (3.1 %)
ECTOPIC PREGNANCY =15 (5.8 %)
INFECTEDWOUND= 14 (5.4 %)
RUPTUREDUTERUS = 7 (2.7 %)
SEPSIS = 11 ( 4.2 %)
OTHERS = 4 (1.5 %)

24. Case of Placenta
Percreta

A 41 years old female Sarfeen w/o Shafeed , P 4 +0 (4 c/s) , widow ,admitted via OPD
with complain of HMB and lower abdominal pain for 3 months, Pt vitally stable and
her hb was 5.6 gm/dl
She was admit in ward for anemia correction and endometrial sampling
After 24 hours of admission in ward patient had an episode of heavy per vaginal
bleeding, upon examination
P/A
Utrerus 14-16 Week size
P/V
V/V – Normal
OS – Open (product of conception felt)
Bleeding + 3

25. Case of Placenta
Percreta

• Meanwhile her pregnancy test was done which was positive, patient was
immediately shifted to LR for evacuation of uterine cavity, during
evacuation placenta was found to adherent with previous scar and patient
started heavily bleeding rushed to OT
• High risk consent was taken from family and On call Consultant was
informed, immediately blood products were arranged and plan of Em
laparotomy made
• Her Em lapratomy proceeded to obs hysterectomy done in view of
placenta percreta
• Total 3 pint PCV and 4 FFPs were transfused and patient was shifted to
surgical ICU for ventilatory support, where she stayed 3 days and shifted
back to ward 8 in stable condition

26. CASEOFScar
Dehiscence
withSepsis
• A 28 yrs Zahida w/o muzamil.P 1 + 0 ( 1 c/s) , c-section done on 8 th August 2024 ,
presented in Gynae causality on 13th post operative day with complain of Fever and
purulent discharge from stitchline
• Pt vitally stable
• On examination :
P / A
• 2 cm wound open with purulent discharge
P / V
• V / V - Normal
• Os - open with unhealthy Lochia
• Her EUA was done and scar was found to dehiscent, so proceeded to Laparotomy
Intraoperative findings:
• Pfannenstiel scar was open of about 2 cm open with purulent discharge, rectus
intact , upon entry into abdomen around 400ml purulent flakes removed, multiple
pus pockets found ,uterus densely adherent to gut which were edematous , GS
were called and gut separation done uterus was mobilized and about 2 cm scar was
dehiscent on right side which was stitched in interrupted manner and cavity
washed with 3 litre of warm N/S
• 2 pint pcv and 4 FFPs were transfused
• Patient shifted to kamal hospital for ventilatory support
• Pt stable and discharged from Kamal Hospital

27. TO
CONCLUDE
 Good antenatal care and vigilant monitoring during and after child birth is
an essential part in minimizing the number of maternal morbidity cases
 Plan of time and mode of delivery for every high risk or low risk delivery should
be made appropriately and discussed with seniors and team timely
 Any risk or threat to the mother either in ante natal period , intra partum or
post partum period should be anticipated on time, prompt discussion with
seniors and consultants , to lessen maternal morbidity and mortality
 Proper councelling and hygiene care should be explained to all patients in their
ante partum and post partum period
 Proper breast feeding and contraception councelling can also minimize
maternal morbidity

28. CONTINUED
We must analyze our all cases of maternal
morbidity and near miss and learn from our
deficiencies to improve maternal care and
provide safest and best services to all the
mothers in future

29. THANK YOU