DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204830

Why do mothers die? A retrospective analysis of maternal mortality over 7 years in a tertiary care teaching Hospital in North Karnataka, India

Rajasri G. Yaliwal, Aruna M. Biradar, Shreedevi S. Kori, SUbhashchandra R. Mudanur, Shivakumar U. Pujeri, Jada Sushmita

Abstract


 

Background: Maternal mortality ratio (MMR) is still high in many developing countries. In Southern India, the maternal mortality is highest in the state of Karnataka. Therefore, a study was conducted at BLDE (DU) Shri BM Patil medical college, hospital and research centre to study the causes of maternal deaths, and to make recommendation to reduce the maternal mortality.

Methods: A retrospective analysis of all the maternal deaths between 2012 to 2019 was done.

Results: A total of 58 women died due to pregnancy and its complications during the period of 2012-2019. Average age of death was 25.42 years. It was noted that 70.7% of the patients travelled over 30 km to reach Vijayapura city. The predisposing causes of death were post-partum haemorrhage (44.8%) eclampsia (18.9%), anaemia (17.2%), pulmonary or amniotic fluid embolism (12.1%), sepsis (10.3%) antepartum haemorrhage (3.4%) and cardiac disease (6.9%). A death each occurred in patients suffering cholestasis and adult respiratory distress syndrome. A majority of the deaths were post-partum deaths (84%). Most of the deaths of the occurred during the first 12 hours of admission (82.76). A total of 11 patients received blood and blood components. Of the 58 deaths, 56(96%) required ventilatory support., 47 (81%) patients received ionotropic support. 11 (19%) patients underwent peripartum hysterectomy.

Conclusions: Timely intervention can save maternal lives. Services of well-equipped hospitals with obstetric intensive care units having a dedicated team of well-trained obstetricians, intensivists and anaesthesiologist are recommended in a facility which is near the residence of the pregnant women. Facilities for quick transfer of the cases who are high risk are required.


Keywords


Maternal mortality, Postpartum eclampsia, Sepsis, Blood transfusion, Intensive care unit

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References


World Health Organization. (‎2019)‎. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. World Health Organization. Available at: https://apps.who.int/iris/handle/10665/327596. License: CC BY-NC-SA 3.0 IGO. Accessed on 24th September 2020.

Telangana at 'striking distance' from targeted MMR. Available at: https://timesofindia.indiatimes.com/city/hyderabad/telangana-at-striking-distance-from-targeted-mmr/articleshow/71974073.cms. Accessed on 24th September 2020.

Special Bulletin on Maternal Mortality in India 2016-18. Sample Registration System Office of The Registrar General, India. Vital Statistics Division, New Delhi. 2018;1-3.

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):e83331.

Sageer R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria. BMC Pregnancy Childbirth. 2019;19(1):63.

Diana S, Wahyuni CU, Prasetyo B. Maternal complications and risk factors for mortality. J Public Health Res. 2020;9:1842.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6): e323-33.

Kumari K, Srivastava RK, Srivastava M, Purwar N. Maternal Mortality in Rural Varanasi: Delays, Causes, and Contributing Factors. Indian J Community Med. 2019;44(1):26-30.

Thobbi VA, Deshpande G, Reddy P. Maternal mortality in Bijapur district. Al Ameen J Med Sci. 2015;8(2):119-24.

Sarma UC, Kakoty SD. Maternal mortality: An equity issue. Indian J Public Health 2017;61:231-2.

Malhotra M. Maternal Death Review-Country Perspective: Presentation at WHO Multicounty Workshop, Bangkok, Thailand. 24-28 September, 2012. New Delhi: Deputy Commissioner, Maternal Health, MoHFW, Government of India. 2012.

Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381(9879):1747-55.