DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175105

Analysis of maternal deaths: autopsy study at tertiary health care center

Ravindra N. Kuralkar, Prabhat Kumar, Narendra Kumar, Ramesh R. Savardekar

Abstract


Background: Every day thousands women died due to complications of pregnancy and child birth globally. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Maternal mortality is a health indicator that shows very wide gaps between rich and poor, urban and rural areas, both between countries and within them. The present study was carried out with view to determine factors causing maternal deaths, causes of maternal deaths and utility of autopsy with autopsy record as a useful and adjunct data source for ascertainment of maternal deaths.

Methods: Total 95 cases of maternal deaths which were brought for postmortem were studied during period of August 2012 to July 2014.

Results: Maximum number of maternal deaths were seen in age group of 21 to 25 years comprising 38 (40.0%) and with maximum cases from low socioeconomic strata. Analyzing the pregnancy outcome, live birth to child were given by 66 (69.5%) against negative outcome in 29 (30.5%) of cases. Post-partum hemorrhage remains the leading cause followed by sepsis 13 (13.7%) in direct causes of maternal deaths. In indirect causes hepatitis leads the list with 4 (4.2%) cases.

Conclusions: Despite the improved methodology, global database on maternal mortality remains weak. Hence forensic pathologist plays important role in identifying these cases with appropriate cause of death. Review of autopsy findings along with hospital records can prove to be one of the useful sources to identify pregnancy related deaths and elucidating the emerging trends.


Keywords


Autopsy, Death, Maternal mortality, Pregnancy

Full Text:

PDF

References


Park K. Text book of Preventive and Social Medicine, 22nd ed. Banarsidas Bhanot Publishers; 2017:516-520

Bedi N, Kambo I, Dhillon BS, Saxena BN, Singh P. Maternal deaths in India: Preventable tragedies (An ICMR task free study). J Obstet Gynecol Ind. 2001;51:68-92.

WHO. Millennium Development Goals (MDGs): Available at http://www.who.int/topics/millennium_development_goals/about/en/

Yadav K, Namdeo A, Bhargava M. A retrospective and prospective study of maternal mortality in a rural tertiary care hospital of Central India. Indian J Community Health. 2013;25(1):16-21.

Puri A, Yadav I, Jain N. Maternal mortality in an urban tertiary care hospital of North India. J Obstet Gynecol India. 2011 Jun 1;61(3):280-5.

Nishu P, Verma A, Verma S. Maternal mortality: ten years retrospective study. 2010;12(3):134-6.

Zaman S, Begum A. Maternal mortality at a rural medical college of Assam: a retrospective study. J Obstet Gynaecol Barpeta. 2014 Mar;1(1):46-51.

Bardale RV, Dixit PG. Pregnancy-related deaths: A Three-year retrospective study. J Indian Academy Forensic Medicine. 2007;32(I):15-18.

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 Jan 15;9(1):e83331.

Paul B, Sen M, Mohapatra B, Kar K. Facility based maternal death review: learning from maternal deaths in a teaching hospital of Eastern India. IJBAR. 2013;04(01):12-20.

Verma A, Minhas S, Sood A. A study on maternal mortality. J Obstet Gynecol India. 2008;58:(3):226-9.

Vidhyadhar B, Giri PA, Garg R. Maternal mortality at tertiary care teaching hospital centre of rural India: A retrospective study. Int J Biomed Res. 2011;2(4):1043-6.

Das R, Biswas S, Mukherjee A. Maternal mortality at a teaching hospital of rural india: A retrospective study. IJBAR, 2014;05(02):114-7.

Paul B, Mohapatra B, Kar K. Maternal deaths in a tertiary health care centre of Odisha: An In-depth study supplemented by verbal autopsy. Indian J Commun Med. 2011;36(3):213-6.

Pal A, Ray P, Hazra S, Mondal TK. Review of changing trends in maternal mortality in rural medical college in West Bengal. J Obstet Gynecol India. 2005;55(6):521-4.

Murthy BK, Murthy MB, Prabhu PM. Maternal mortality in tertiary care hospital: A 10 year review. Int J Prev Med. 2013;4(1):105-9.

Singh R, Sinha N, Bhattacharyya K, Ram R. Pattern of maternal mortality in a tertiary care hospital of Patna, Bihar. Indian J Community Med. 2009 Jan 1;34(1):73.

Toppo NA, Nayak S, Kasar P, Sahu B. Maternal deaths review: an approach towards improving maternal health. JEMDS. 2014;3(53):12316-26.

Mundkur A, Rai L. Prepare and prevent rather than repair and repent: Study of maternal mortality in tertiary care hospital. Int J Med Public Health. 2013;3(3):163-7.

Kullima A, Kawuwa MB, Audu BA, Usman H, Geidam AD. A 5 year review of maternal mortality associated with eclampsia in tertiary institution in northern Nigeria. Annals Afr Med. 2009;8:81-4.

Padmaleela K, Thomas V, Prasad KV. An Analysis of the Institutional Deliveries and Their Outcomes in Government Teaching Hospitals of Andhra Pradesh, India. Int J Health Sci Res. 2013;3(5):76-81.

Mukherjee S, Mukherjee S, Sarkar RR. A Six year retrospective study of maternal mortality at a tertiary teaching institute in Uttar Pradesh. Int J Med Sci Public Health. 2014;3(11).

Yerpude P, Jogdand K. A 5 year retrospective study of pattern of maternal mortality in a tertiary care hospital in South India. Inte J Recent Trends Sci Tech. 2014;11(3):310-2.

Gumanga SK, Kolbila DZ, Gandau BBN, Munkaila A et al. Trends in maternal mortality in Tamale teaching hospital, Ghana. Ghana Med J. 2011;45(3):105-110.

Shah P, Shah S, Kutty RV, Modi D. Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5. Trop MedInt Health. 2014;19(5):568-75.