Maternal Mortality in the Remote Islands of India—Unraveling the Conundrum

Abstract

Introduction: Reduction in maternal mortality has been a top priority in low- and lower middle-income countries of Asia-Pacific region. India, being one of them, has a major responsibility of reducing maternal mortality especially in light of the commitment on the part of the Sustainable Development Goals. Despite massive efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high especially in remote areas. This study aims at collecting the MMR data and analyzing in the context of island infrastructure. Material and Methods: This was a hospital-based cross-sectional study. The records of maternal deaths from January 2010 to December 2019 were collected from the medical record section and analyzed. Results: The MMR was estimated to be 95.63 per 100,000 live births. Majority of the patients were multigravida (82%) in the age group of 21 to 30 years (75%). Around 64% of them were referred cases. Majority (86%) of the deaths occurred in the postpartum period. Hemorrhage was the leading direct cause of maternal deaths (35.7%) followed by hypertensive disorders of pregnancy (HDP) (21.4%). Conclusion: Most maternal deaths are preventable. Early detection of high-risk pregnancies and early referral of such patients to a well-equipped center is the key to curb the catastrophe of mortality. Adopting methods like qSOFA (quick sequential organ failure assessment) for identifying patients requiring intensive care and miniPIERS (Preeclampsia Integrated Estimate of RiSk) model for predicting adverse outcome in HDP is the need of hour. More efforts should be made to retain the specialists in the islands.

Maternal mortality: a 6-year experience of the triumph achieved and the hardships faced in a tertiary care centre of Chhattisgarh

“…During the study period about 75% to 96% women were referred from multiple centers with 57% of them being referred from 1 referral center and 42% from 2 referral centers which was also seen in study by Shobha et al 9,12 Even though percentage of referral is varied but still stand high. Sometimes due to being referred from multiple centers women are brought in such grave conditions that in spite of being a multispecialty center we feel helpless.…”

“…Maternal mortality was maximum in the age group of 21 to 25 years also seen in study conducted by Meh et al, as majority of our patients belonged to this age group and was consistent throughout the study period. 8,12 Although deaths in teenage pregnancy gradually declined from 21.1% to 14% which may be due to improvement in female education, changing norms in society resulting in decreased number of child marriages and development of adolescent health clinics which led to proper guidance about contraceptive measures.…”

“…10,11 Amongst direct causes, hypertensive disorders of pregnancy (HDP) were the leading cause of death which was also seen in study by Shobha et al, which declined from 46% in 2016 to 38% in 2021. 9,12,14 This decline may be because of better counselling, regular and frequent blood pressure checkups, early pickup of warning signs of Although in 2016 pulmonary edema was the main immediate cause of death in women of HDP, leading to prolonged ventilatory support and its sequelae. Aggressive critical care management has resulted in significant improvement in this area.…”