Abstract
Objective: To study the types and frequency of maternal near miss event cases at a tertiary care center.
Methodology: This descriptive study was conducted at Combined Military Hospital, Sialkot which is a tertiary care set up. Patients undergoing a major morbidity or mortality event from 1st December 2016 to 31st October 2017 fulfilling the WHO severity criteria were included in the study. Cases were identified based on laboratory findings, clinical assessments, or management procedures. Frequencies and types of near misses were noted, and the data were used to calculate maternal mortality ratio, maternal near miss incidence ratio per 1000 live births, maternal near miss to mortality ratio and mortality index.
Results: Total patients attended at the outpatient during study period were 25900. There were 3372 deliveries and 3360 live births; 64 patients fitted the WHO severity criteria. Patients surviving a major morbidity event were 54. Morbidly adherent placentation accounted for 25.92%. Deaths were 8 during due to eclampsia followed by hemorrhage. The maternal mortality ratio and near miss incidence ratio per 100,000 live births was 238 and16.07, respectively. Maternal near miss to mortality ratio came out as 6.75: 1. Mortality index was 12.90.
Conclusion: Eclampsia and hemorrhage remain the main cause of morbidity and mortality. Documentation, registrations of maternal mortalities and audits of near miss events must be made mandatory for all medical facilities, as analyzing them can overcome their shortcomings and raise its standard of care by learning from the deficiencies.

Key words: Maternal mortality, maternal near miss, eclampsia, post-partum hemorrhage.