An Analysis of Maternal Deaths in a Tertiary Care Centre

Abstract

BACKGROUND: Maternal death has been recognized as an area of maternal care that requires urgent attention.Making efforts to decrease maternal mortality is a matter of great concern to the obstetricians. MMR is a very sensitive index that reflects quality of reproductive care provided to the pregnant woman.OBJECTIVES: The aims of the study were to help generate information and knowledge regarding the causes and complications leading to maternal deaths (MDs) in an urban tertiary care hospital, to find if any of them are potentially preventable, and to use information thus generated to save lives.METHODS: It was a retrospective study.The medical records of all maternal deaths occurring over a period of 4 years between January 2010and December 2013 were reviewed and correlated with maternal age, antenatal registration, mode of delivery, parity, admission death interval, and causes of death.RESULTS: The maternal mortality rate (MMR) ranged between 926 and 377/100,000 births in the study period. The causes of deaths were sepsis 23.84%, eclampsia/pregnancy-induced hypertension 17.69%, hemorrhage 13.84%, hepatitis13.84%, anemia 13.07%, respiratory infections 8.46%, other indirect obstetrical causes 6.15%, and unrelated causes 4.61%.Maximum deaths (71.53%) occurred in women between 21 and 30 years of age while multigravida had MMR of 51.53%. Mortality was highest in postnatal mothers 63.06%.Unbooked cases constituted 92.31% of MDs and included 25% referred cases. Conclusion: Overall maternal mortality was 690/100,000. MDs due to direct obstetric causes were 55.38%, indirect obstetric deaths 40%, and unrelated deaths 4.61%. The causes of potentially preventable deaths include deaths due to anemia, sepsis, hemorrhage, DIC, and anesthesia complication, and accounted for 25.38% of all deaths.

Pattern of Obstetric Referrals in a Tertiary Hospital in South Kerala

“…Morsheda et al 3 reported 74% in the age group 20-35 years. 82.3% were from the rural area in our study, similar to the study by Vinayak et al 4 wherein they had 80.5%; Wahane et al 5 reported 77% from the rural set up. This high proportion of rural population may be due to delay in access to health care and lack of awareness and poor transport facilities.…”

Spectrum of obstetric referral and their outcome at a Tertiary Care Center of Eastern Uttar Pradesh: An insight

“…This high proportion of ignorant rural population could be a reason for delayed access to health-care services. This was consistent to the studies performed by Vinayak et al 15 and Wahane and Koranna 16 who reported a rural domicile of 77%.…”

Analysing maternal determinants and characteristics of obstetric referrals at a tertiary care centre in Kerala, India

“…In a study conducted by Vinayak et al, only 11% patients travelled by ambulance. 11 Only 38% referrals travelled in ambulance while 62% patients used their private vehicles in Gwalior study. 6 58% travelled in ambulance provided by the referring hospital while 24% had to hire a private vehicle for inter-hospital transfer .Arranging a private vehicle when faced with obstetric emergency necessitating referral takes time and costs money.…”

“…There were 82.3% were from the rural area, also in Vinayak et al and Wahane et al reported 77 %. [11][12] This high proportion of rural population may be due to delay in access to health care and lack of awareness and poor transport facilities. Infertility treated obstetric referrals were at significant risk of referral (p value=0.002).…”