Objectives. (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index. (2) To compare the nature of near miss events with that of maternal mortality. (3) To see the trend of near miss events. Design. Audit. Setting. Kasturba Hospital, Manipal University, Manipal, India. Population. Near miss cases & maternal deaths. Methods. Cases were defined based on WHO criteria 2009. Main Outcome Measures. Severe acute maternal morbidity and maternal deaths. Results. There were 7390 deliveries and 131 “near miss” cases during the study period. The Maternal near miss incidence ratio was 17.8/1000 live births, maternal near miss to mortality ratio was 5.6？:？1, and mortality index was 14.9%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hemorrhage was the leading cause (44.2%), followed by hypertensive disorders (23.6%) and sepsis (16.3%). Maternal mortality ratio (MMR) was 313/100000 live births. Conclusion. Hemorrhage and hypertensive disorders are the leading causes of near miss events. New-onset viral infections have emerged as the leading cause of maternal mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices. 1. Introduction As we move closer to 2015, the goal number 5 of the millennium development goals (MDG), to improve maternal health is falling way below our target. Our target in reducing maternal mortality by 75% has not been met with [1]. Pregnant women’s health status is not reflected by mortality indicators alone. Hence the concept of severe acute maternal morbidity (SAMM) is apt for the present health providing system [2, 3]. SAMM has been studied extensively in the recent past as a complement for maternal mortality and also to evaluate the quality of obstetric care in that particular institution. This concept is superior over maternal death in drawing attention to surviving women’s reproductive health and lives and is equally applicable in developing countries as well as developed countries. In many developed countries, maternal mortality has fallen to single digits whereas near miss cases are more and hence useful in evaluation of the present system. Moreover, they have the advantage of not being as rare as maternal deaths for providing adequate information, as well as still being rare enough not to overload clinicians and data collection personnel within the facility [4]. Till recently there were no set criteria for identification of these cases for routine
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