The changing trends and tendencies in maternal mortality: a compare and contrast spanning two decades
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20212655Keywords:
Maternal mortality ratio, Changing trends, Maternal health policies, Hypertensive diseases of pregnancy spectrum, HaemorrhageAbstract
Background: Though the maternal mortality ratio has been on the constant decline over two decades we shall strive forward to prevent all preventable maternal deaths and we have a long way to reach the SDG 3.1 goal. So, it becomes imperative to further reduce the mortality rates by continuously reviewing and upgrading our health policies. The aim of the study was to compare the trends in maternal mortality in 2002-2011 to the current predicament in 2017- 2019 in our hospital.
Methods: Data was collected for all maternal deaths in the Institute of obstetrics and gynaecology, Egmore, Chennai- a centre of excellence for maternal care in South India, in terms of age at time of death, parity, period of death, mode of delivery, the cause of death and the admission to delivery interval and compared between the time periods of 2002-2011 and 2017-2019 to identify the changing patterns.
Results: The maternal mortality ratio has consistently declined over the years from 220 in 2002 to 110 in 2019. The age group of 20-29 years and primigravidae continue to amount for most mortality. The postpartum period remains the most susceptible period. There is a significant increase in the number of caesarean deaths (64% from 46%). Significant transition in the cause of death from haemorrhage (20% to 7%) to hypertensive disease of pregnancy (23% to 35%) as leading cause of maternal mortality has been witnessed.
Conclusions: Significant difference in the trends over two decades in maternal mortality lies in the fact that the leading cause of maternal mortality has changed from haemorrhage to hypertensive diseases and sepsis and they have continued to occupy the top spots for the past decade. Preventive measures are the solution to reduce maternal mortality due to either of the causes.
References
National Health Mission. Guidelines for maternal death surveillance and response- National Health Mission, 2017. Available at: https://nhm.gov.in/imageprogrammesmaternalhealthguidelines. Accessed on 13 May 2021.
GOI. Special bulletin on maternal mortality in India 2016-2018, 2020. Available at: https://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR%20Bulletin%202016-18.pdf. Accessed on 13 May 2021.
United Nations. Sustainable Development Goals, Goal 3 targets, 2021. Available at: https://www.un.org/sustainabledevelopment/health/. Accessed on 13 May 2021.
UNICEF. Trends in estimates of maternal mortality ratio (MMR), maternal deaths and lifetime risk of maternal death, 2000-2017, 2017. Available at: https://data.unicef.org/wpcontent/uploads/2015/11/MMR-maternal-deaths-andLTR_MMEIGtrends_2000-2017-revised.xlsx. Accessed on 13 May 2021.
NHS. Maternal Health Program Annual Report 2013-2014- National Health Mission, 2014. Available at https://main.mohfw.gov.in/sites/default/files/Chapter415.pdf. Accessed on 13 May 2021.
Surakshit Matritva Ashwasan (SUMAN). Standard Operational Guidelines- National Health Mission, 2021. Available at: http://www.nhm.gov.in/index1.php?lang=1&level=3&sublinkid=839&lid=377. Accessed on 13 May 2021.
Ministry of Health and Family Welfare, GOI. State fact sheet- Tamil Nadu- National Family Health Survey 4. 2015-2016, 2016. Available at: r chiips.org/nfhs/pdf/NFHS4/TN_FactSheet.pdf. Accessed on 13 May 2021.
Ashraf AM, Babitha MC, Lokeshchandra HC, Sharma KD, Zehra M, Reddy MS. A study of changing trends of maternal mortality at the tertiary care centre, MMC & RI Mysore, India. Int J Reprod Contracept Obstet Gynecol 2015;4:239-42.
Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. Lancet Glob Health. 2014;2(3):155-64.
Blanc AK, Winfrey W, Ross J. New findings for maternal mortality age patterns: aggregated results for 38 countries. PLoS One. 2013;8(4):59864.
Dietl A, Cupisti S, Beckmann MW, Schwab M, Zollner U. Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age. Geburtshilfe Frauenheilkd. 2015;75(8):827-32.
Arup KM, Sanyal P, Chakraborty B. Changing trends in maternal mortality at a teaching cum referral hospital. J Obstet Gynecol India. 1996;345-51.
Soni M, Agrawal S, Soni P, Mehra H. Causes of Maternal Mortality: Our Scenario. J South Asian Feder Obst Gynaecol. 2013;5(3):96-8.
Onakewhor JU, Gharoro EP. Changing trends in maternal mortality in a developing country. Niger J Clin Pract. 2008;11(2):111-20.
Montgomery AL, Ram U, Kumar R, Jha P, Million Death Study Collaborators. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014;9(1):83331.
Say L, Chou D, Gemmill A, Tunçalp O, Moller AB, Daniels J, Temmerman M, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):323-33.
Verma A, Minhas S, Sood A. A study on maternal mortality in Dr. Rajendra Prasad Govt. M.C. Tanda Dist. Kangra, H.P. (Jan. 1999-Dec. 2005). Indian J Obstet Gynaecol. 2008;58(3):226-9.
Mukherjee S, Theengh C, Bhattacharya S, Maru L. Maternal mortality at a tertiary care institute of central India. Asian J Obstet Gynaecol Pract. 2010;4:23-7.
Goldenberg RL, Jones B, Griffin JB, Rouse DJ, Kamath BD, Trivedi N, et al. Reducing maternal mortality from preeclampsia and eclampsia in low-resource countries--what should work? Acta Obstet Gynecol Scand. 2015;94(2):148-55.
Clark SL, Christmas JT, Frye DR, Meyers JA, Perlin JB. Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage. Am J Obstet Gynecol. 2014;211(1):32.
Herrera JA, Herrera MR, Herrera JP, Nieto A. Reduction of maternal mortality due to preeclampsia in Colombia--an interrupted time-series analysis. Colomb Med. 2014;45(1):25-31.
Nyflot LT, Ellingsen L, Yli BM, Oian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand. 2018;97(8):976-87.
