Near Miss Cases and Their Outcome in PUMHS Tertiary Care Center Nawabshah

Background: Maternal near-miss (MNM) cases represent instances where women survive severe, life-threatening obstetric complications. These cases provide critical insight into healthcare system performance and opportunities to reduce maternal mortality. Understanding the indications, complications, and outcomes of MNM is essential to guide preventive strategies in resource-limited settings. Objective: The purpose of this study is to identify the factors contributing to maternal near-miss cases at People’s University of Medical & Health Sciences (PUMHS) Tertiary Care Center, Nawabshah, focusing on major indications, associated complications, and clinical outcomes. Methods: This cross-sectional study included 50 women who met WHO criteria for MNM between May 03, 2024 and November 02, 2024. Data on demographics, parity, gestational age, indications for admission, mode of delivery, surgical details, blood loss, transfusion requirements, postoperative complications, and psychological effects were collected. Statistical analysis involved descriptive frequencies, percentages, and trend assessment. Results: Participants ranged from 17 to 44 years, with a mean age of 32.2 years; parity 1 was most common (28%). Most presented at the term. Uterine rupture (24%), postpartum hemorrhage (22%), and obstructed labour (22%) were the leading indications. Cesarean section was the predominant delivery mode. Of 35 surgical patients, 20% sustained bladder or bowel trauma, with blood loss ranging from 500–3000 ml; 90% required transfusion. Postoperative complications included fever (24%), wound infection (24%), urinary tract infection (14%), and chest infection (8%). Psychological distress was reported in 58% of cases. Outcomes showed 70% discharged healthy, 24% referred due to organ dysfunction, and 6% mortality. Conclusion: Preventable causes—particularly uterine rupture, postpartum hemorrhage, and obstructed labour—remain major contributors to MNM. Strengthening early detection, timely referral, and intrapartum monitoring, along with improving surgical care, transfusion services, and mental health support, could significantly improve maternal outcomes. Multicenter research is needed to develop targeted interventions in similar low-resource contexts.