Review of Maternal Mortality at a Tertiary Care Hospital: What Have we Achieved?

Mittal, Pratima; Kapoor, Garima; Kumari, Neelam; Bajaj, Bindu

doi:10.1007/s13224-018-1129-1

Cited by 7 publications

(25 citation statements)

References 5 publications

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“…Earlier studies have also reported similar reasons for increased maternal deaths. 9,10 Majority of the death (37.5%) was observed in 20-24 years of age which is consistent with earlier studies and the national data. 3,6,8,10 Present study reported an equal proportion of maternal deaths in primipara and multipara.…”

Section: Discussionsupporting

confidence: 91%

“…3 The MMR in this study is comparable to the results of Sundari et al (802) but very high in comparison to the other previous studies. [6][7][8][9] The high maternal mortality ratio in the present study can be explained by the fact that our centre is a tertiary referral centre attending large number of referred complicated cases and most of the patients are referrals from distant places. Most of the cases presented at late stage with serious complications (66.07%) and expired within 24 hours of admission (53.57%).…”

Section: Discussionmentioning

confidence: 81%

“…This result is varying from prior studies by Mittal et al and Soni et al where more maternal deaths were observed in multipara. 9,10 This study reflects that pregnancy of any order can develop complications leading to mortality. According to NFHS, In India and Chhattisgarh the proportion of women receiving antenatal care at least once during pregnancy was about 82.7% and 95.7% respectively for the period 2015-2016, but for the recommended minimum of four or more visits the corresponding figure drops to around 51.2% and 59.1% respectively.…”

Section: Discussionmentioning

confidence: 91%

“…In this study, hypertension (36.61%) was the major direct cause of maternal death which is consistent with the earlier studies. [7][8][9] A WHO systemic analysis on global cause of maternal deaths revealed haemorrhage as the major cause of maternal mortality worldwide. 14 Obstetric haemorrhage is also the leading cause of maternal deaths in India.…”

Section: Discussionmentioning

confidence: 99%

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Maternal mortality review by three delay model: a retrospective study from a tertiary care hospital of Chhattisgarh

Jogi

Ekka

2020

Int J Reprod Contracept Obstet Gynecol

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Background: SDG 3 includes an ambitious target of reducing the global MMR to less than 70 per 100 000 births by 2030. In order for effective initiation of measures to reduce maternal mortality it is necessary to assess the levels of delays, causes of death, health seeking behavior during antenatal and postnatal period and obstacles in reception of health services.Methods: Retrospective study of 112 maternal death cases from a tertiary medical centre (Medical College) was done. The details of all the maternal mortalities from January 2018 to July 2020 were collected from the individual case sheets, facility-based maternal death review form and MDR Case Summary.Results: The study reported a very high MMR of 802. Hypertensive disorders (36.61%), Obstetric haemorrhage (25.89%) and Sepsis (14.29%) constituted the major direct cause of maternal deaths whereas anaemia was the most common indirect cause (7.14%). First, second and third delays were present in 95.54%, 70.54% and 47.32% cases respectively.Conclusions: Suboptimal ANC, long distances to reach final hospitals, high number of referrals and admission during complicated stage explains the very high maternal mortality in the present study. Application of Three Delay Model revealed that most of the maternal death occurred due to delays in multiple levels and first delay was the most commonly identified delay. Accelerated efforts should be implemented to minimize all the delays in order to achieve SDG goals.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Maternal mortality review by three delay model: a retrospective study from a tertiary care hospital of Chhattisgarh

Jogi

Ekka

2020

Int J Reprod Contracept Obstet Gynecol

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“…Remarkably the great majority of women who died had attended some form of ANC, while only 7.2% did not attended even once. This is paradoxical to other studies, in which most maternal deaths occurred in unbooked women [33][34][35]. This paradox is in agreement with official reports of the Egyptian ministry of health and may be explained from the point of view that women with high risk pregnancies receive ANC while women with low risk pregnancies do not book for ANC.…”

Section: Discussionsupporting

confidence: 70%

A ten year analysis of maternal deaths in a tertiary hospital using the three delays model

Mohammed

Gelany

Eladwy

et al. 2020

BMC Pregnancy Childbirth

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Background Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services’ coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. Methods During a 10 year period (2008–2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. Results From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. Conclusions There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers’ training. Trial registration This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

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New Concept and Management for Sepsis in Pregnancy and the Puerperium

Fan

Liu

Yan

et al. 2020

Maternal-Fetal Medicine

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Sepsis, which is life-threatening organ dysfunction resulting from a dysregulated host response to infection, remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality. The obstetric causes include uterine infection, septic abortion, and wound infection. The non-obstetric causes include pyelonephritis and pneumonia. Maternal sepsis may also be from obstetrical critical illness, such as obstetric severe hemorrhage, obstetric (amniotic fluid/pulmonary) embolism, acute fatty liver of pregnancy, and congestive heart failure, cardiopulmonary arrest, and major trauma. The most commonly reported pathogens in maternal sepsis include Escherichia coli, Streptococcus, Staphylococcus, and other gram-negative bacteria. Maternal sepsis may cause intrauterine infection, which results in (1) preterm premature rupture of membranes or preterm labor or birth, (2) cerebral white matter damage or cerebral palsy or neurodevelopmental delay, (3) stillbirth, (4) early- or late-onset sepsis, and (5) perinatal death. The “Hour-1 bundle” should be initiated within the first hour of the recognition of sepsis. The use of early, appropriate antibiotics is crucial in the management of maternal sepsis. Fetal status should be monitored. Appropriate and early source control should be provided. The decision for delivery is often quite complex and should be individualized to each patient's clinical scenario while taking into consideration the suspected source of infection, maternal status, fetal well-being, and gestational age. Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.

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Review of Maternal Mortality at a Tertiary Care Hospital: What Have we Achieved?

Cited by 7 publications

References 5 publications

Maternal mortality review by three delay model: a retrospective study from a tertiary care hospital of Chhattisgarh

Maternal mortality review by three delay model: a retrospective study from a tertiary care hospital of Chhattisgarh

A ten year analysis of maternal deaths in a tertiary hospital using the three delays model

New Concept and Management for Sepsis in Pregnancy and the Puerperium

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