BackgroundMaternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.ObjectiveThe objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital.MethodologyThis was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009). All pregnancy-related deaths of patients managed at the hospital were included in the study.ResultsA total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3%) of the deaths were in women aged 20–34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%), followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%). About 69.26% of these women had no antenatal care. The majority (61.04%) died within the first 48 hours of admission.ConclusionAlthough there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially Type III delay. Efforts must be put in place by government, hospital management, and society to reduce these figures further. Above all, there must be an attitudinal change towards obstetric emergencies by health care providers.

Asthma occurring in pregnancy was associated with increased antenatal complications, increased perinatal loss and congenital malformations in our study population.

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This study was conducted to determine the frequency of antenatal intrauterine fetal death (IUFD) and the associated maternal and fetal risk factors in women who presented at a regional tertiary hospital in Saudi Arabia. Over a 5-year period, 191 consecutive cases of IUFD presented and were studied prospectively. Relevant maternal and fetal data were obtained. The stillbirth rate during the period was 10 per 1000 deliveries. In 41% of the cases, the associated causal factors could not be determined. There was a significant (P = 0.00122) linear trend showing an increased risk of IUFD above the age of 20 years and, similarly, a significant (P = 0.00047) linear trend after the first pregnancy. Lack of antenatal care (88.5%), hypertensive diseases in pregnancy (12%) and diabetes mellitus (8%) were associated risk factors while 'major congenital malformation' (14%) was an outstanding fetal factor. The risk factors of antenatal stillbirth in our community seem to be avoidable. Health education to encourage the utilisation of the available antenatal care services, family planning and genetic counselling are being advocated strongly as possible preventive measures.

An intervention to build the capacity of care-providers to use an evidence-based protocol for the treatment of eclampsia in Nigeria was successful in reducing associated case fatality rate. The increased and widespread use of such an intervention in maternity units might contribute to the reduction of maternal mortality in low-income countries.