| Summary: | <p>Objective: To assess the feasibility of establishing a simple maternal morbidity surveillance system in Assam (Indian Obstetric Surveillance System-Assam (IndOSS-Assam)) to investigate the incidence and trends in severe maternal complications. This study presents the surveillance platform of IndOSS-Assam.</p><p> Design: Four tasks were undertaken: (i) setting up a steering committee; (ii) establishing priorities for the region; (iii) mapping of surveillance sites; (iv) piloting case-notification system in selected centres.</p><p> Setting: Two government tertiary hospitals in the state.</p><p> Study population: Pregnant women delivering in the hospitals between March and August 2015.</p><p> Main outcome measures: Incidence and case fatality rates with 95% confidence intervals.</p><p> Results: Local stakeholder ownership and a simple uncomplicated anonymous system for case notification were the key strengths of this project. Cases and deaths were reported for six conditions: eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure. Among 10,475 women delivering over six months, 402 had one of these conditions and 66 died (case fatality 16%). The incidence of eclampsia was 17 per 1000 deliveries (95%CI=14 to 19), postpartum haemorrhage 11 per 1000 deliveries (95%CI=10 to 13) and anaemic heart failure was 3 per 1000 deliveries (95%CI=2 to 5). For each of the other three conditions, puerperal sepsis, septic abortion and uterine rupture, the incidence rate was 2 per 1000 deliveries. </p><p> Conclusion: IndOSS-Assam was shown to be a feasible and simple system for ongoing surveillance of maternal morbidity which can be used to monitor the trends in the incidence of specific severe life-threatening conditions during pregnancy.</p>
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