A Five-year Retrospective Analytical Study on Maternal Mortality in a Tertiary Referral Hospital in Northern Kerala, India

Abstract

Aim: To assess the maternal mortality ratio (MMR), epidemiological aspects, and the causes of maternal mortality according to the International Classification of Diseases, 10th Revision (ICD-10). Materials and methods: This is a retrospective observational study of maternal deaths that occurred at Government Medical College, Kozhikode. The data were collected from patients' records and maternal mortality register maintained by the medical records library of the hospital. Maternal deaths during the period of January 2011 to December 2015 were analyzed with emphasis on sociodemographic profile and deliveryrelated characteristics. Identification and classification of the cause of maternal deaths-direct and indirect, along with further subdivisions (nine subgroups), were done according to World Health Organization (WHO) application of ICD to deaths during pregnancy, childbirth, and the puerperium [ICD-Maternal Mortality (ICD-MM)], which is based upon the 10th revision of ICD. Results were analyzed using percentage and proportion. Results: There were 77,065 live births and 90 maternal deaths during the study period. The average MMR was 117 per 1 lakh live births. Maximum maternal deaths were in the 20 to 24 years age group and in multigravida. Total 40% of the deaths occurred in term patients and following vaginal delivery. The direct causes constituted 61.11%, the indirect causes constituted 34.44%, and unknown cases constituted 4.44%. Conclusion: The ICD-MM Group VI (nonobstetric complications), composed of numerous common and uncommon diseases, is the single largest cause of maternal mortality. "Hypertensive disorders of pregnancy" is the leading direct cause of maternal mortality closely followed by obstetric hemorrhage, embolism, and sepsis. Improvement of general health of the women and also having a planned pregnancy especially in those with preexisting medical disorder is advisable.