Published: 2022-08-29

Using the new ICD-MM classification system for attribution of cause of maternal death: a retrospective study from a tertiary care hospital of Rajasthan

Anuj Kumar Sharma, Radha Rastogi, Archana Bamaniya, Sumeet Ranjan Tripathy, Balveer Jakhar, Kalpesh Patel


Background: Sustainable development goal 3 includes an ambitious target of reducing the global maternal mortality rate (MMR) to less than 70 per 100,000 births by 2030. Understanding the causes of and factors contributing to maternal deaths is critically important for development of interventions that reduce the global burden of maternal mortality and morbidity. The International classification of diseases-maternal mortality has proven to be easily applicable and helps clarify the cause of maternal death.

Methods: Retrospective study of 100 maternal death cases was done in a tertiary medical centre of Rajasthan from December 2020 to November 2021 for determining the causes of maternal death and their classification according to ICD-MM.

Results: A total of 100 maternal mortality cases were analyzed in this study for causes of death. Classification of causes of death according to WHO ICD-MM is represented in study results. Direct causes of maternal deaths were observed in 82 % cases whereas indirect causes were present in remaining 18%. Hypertensive disorders (29%), obstetric haemorrhage (27%) and pregnancy related infection (12%) constituted the major groups of direct cause of maternal deaths whereas systemic infections were the most common indirect cause (15%). During the study period, COVID-19 was attributable to 12 cases of maternal death.

Conclusions: Hypertensive disorders (29%), obstetric haemorrhage (27%) and pregnancy related infection (12%) were the major causes of direct obstetric death and systemic infections (15%) was the most common cause of indirect obstetric death. All of these causes are preventable with targeted interventions.


ICD-MM, Maternal death classification, Maternal mortality, COVID-19

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