Analysis of maternal deaths over a period of three years at a tertiary care centre of Uttarakhand, India

Abstract

Background: Globally, about 800 women die every day of preventable causes related to pregnancy and childbirth; 20 per cent of these women are from India. The study is aimed at evaluating maternal deaths over a period of three years at a tertiary care centre of Dehradun, India.Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology at SGRRIMHS, Dehradun. The case record files of all maternal deaths from January 2015 to December 2017 was obtained from medical record section of the hospital. Maternal age, parity, educational status, antenatal registration, mode of delivery, admission death interval and causes of each maternal death was noted and analysed statistically.Results: There were 48 maternal deaths from January 2015 to December 2017.Maximum deaths were in the age group of 21-25 years. The maternal mortality ratio over a period of three years was 671 per one lac live births. Most of the maternal deaths were due to direct causes like hemorrhage , eclampsia followed by sepsis.Conclusions: Most of the maternal deaths are preventable. High risk cases should be identified at root level and early referral should be the moto. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. To avoid maternal deaths, unwanted and too-early pregnancies should be avoided. All women, including adolescents, should have access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby.

Pathological Study of Maternal Deaths - Experience from a Tertiary Care Centre in Central India

“…Non availability of hygienic conditions during delivery could explain the development of sepsis in these cases. Pulmonary embolism, hepatic disease of pregnancy, ectopic pregnancy, abortion related death were the other causes of MD as seen in the other studies 8,16 In pregnancy hepatitis E virus infection has a bad prognosis. It leads to fulminant hepatic failure and death in up to 60% cases.…”

A Comprehensive Review of Causes and Determinants of Maternal and Infant Mortality in Uttarakhand

“…Maternal conditions such as haemorrhage, hypertensive disorders, sepsis/ infections and obstructed labour contribute to the highest rates of preterm birth, severe infections (sepsis, meningitis), and intrapartum-related complications like birth asphyxia (Darmstadt et al, 2015). Important to note that women between 25 and 29 years of age group were less likely to die in pregnancy (Horwood et al, 2020); only 25% of deaths were between 26 and 30 years of age group (Ramola et al, 2018). Also, infant mortality is slightly higher (44) in urban than rural areas (38).…”

“…In Uttarakhand, the common direct causes of maternal mortality include haemorrhage (22.9%), eclampsia (14.6%), sepsis (10.6%), rupture of the uterus (6.2%), and ectopic pregnancy (2.1%) and pulmonary embolism (2.1%) also contributed to it. Anaemia (16.6%), jaundice (12.5%), heart diseases during pregnancy (6.2%), and other communicable diseases (6.3%) were the indirect causes of maternal mortality (Ramola et al, 2018). Overall, it is considered that across the country, haemorrhage contributes to 38% of maternal deaths, and anaemia also stands consistent with high rates.…”

“…Women between 13 and 19 years (youngest age group) were at the highest risk of death during pregnancy and followed by the eldest age group of women between 40 and 49 years. Important to note that women between 25 and 29 years of age group were less likely to die in pregnancy (Horwood et al, 2020); only 25% of deaths were between 26 and 30 years of age group (Ramola et al, 2018).…”

“…• Biological Factors: Being multigravida is also a risk factor for most of the women to die (66.7%) (Ramola et al, 2018). Medical comorbidities like hypertensive disorders during pregnancy, bleeding, sepsis anywhere in the body, prolonged and/ obstructed labour were reported to be associating factors for maternal mortality.…”