A ten year audit of maternal mortality: Millennium development still a distant goal

Abstract

Objective:To assess various causes of maternal mortality over a ten year periodDesign:Retrospective audit of hospital case recordsSetting:Tertiary care hospitalPopulation:Pregnant women who expired in the premises of GTB Hospital.Materials and Methods:A retrospective audit of case records of maternal deaths was conducted for a ten year period (January 2005 to December 2014).Results:There were a total of 647 maternal deaths out of 1,16,641 live births. Sixty-eight percent (n = 445) of women were aged 21-30 years, while 10.5% (n = 68) were <20 years of age. The most common direct causes of maternal mortality were preeclampsia/eclampsia in 24.4% (n = 158), obstetric hemorrhage in 19.1% (n = 124) and puerperal sepsis in 14.5% (n = 94). With regards to indirect causes, anemia accounted for 15.3% (n = 99) mortality. There was only 1 (0.1%) mortality because of HIV/AIDS. Other notable causes of maternal mortality were infective hepatitis in 7.1% (n = 46). Tuberculosis, that is a disease of tropical countries, accounted for 3.0% (n = 20) of the total deaths.Conclusion:High maternal mortality in GTB hospital can be due to it being a tertiary hospital with referrals from all neighbouring states. Accessible antenatal care can help prevent these maternal deaths. Female education can be of immense help in dealing with the problem and improving the utilization of public health facilities.Key Message:Preeclampsia/eclampsia and obstetric hemorrhage have been the main causes of maternal mortality for ages. Regular antenatal visits and the judicious training of grassroot level workers to pick-up complications early on in the pregnancy can be an effective way to deal the morbidity and mortality associated with these problems. The Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK) in India are pioneer steps in this direction.

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

“…Anaemia has been identified as an important indirect cause of mortality. [ 24 ] Although antenatal anemia was not recorded in this study, severe anaemia in the peri-operative period was associated with a high mortality index. In contrast to other studies, mortality in obstetric patients with cardiac disease was low in our study.…”

Severe preeclampsia and eclampsia: adverse obstetric outcomes and prognostic factors

“…Singla et al, in the 10 years audit of MD at a tertiary hospital in Delhi reported 24.4% of MD due to hypertensive diseases in pregnancy. 7 While Kaur et al in the 7 years Chandigarh based study found just 8.8% of MD caused by hypertensive disorders. 8 A FOGSI study found that hypertensive disorders (eclampsia and severe preeclampsia) remained as the leading cause in the east (34%) and the north (22%) zones of India.…”

Blood transfusion practices in obstetric patients at a tertiary care institute during COVID-19 first wave: The need to re-strategize

“…10. Obstetric hemorrhage, pre-eclampsia with its complications and sepsis are most common causes of maternal mortality in India, while anemia is the commonest indirect cause for maternal mortality [13] . A timely transfusion can save the life in such situation.…”