Maternal mortalities due to infectious diseases at a tertiary care centre in India

Meena Naresh Satia, Shruti Ashok Panchbudhe, Manali Prakash Shilotri


Background: Maternal death and poor birth outcomes are major public health issues in much of the world. Most of the mortality and morbidity burden around child birth are directly due to obstetrical problems such as haemorrhage. However, there is very little information on the importance of the great diversity of infectious diseases on pregnancy outcome, especially in the tropics. There is poor evidence as to whether obstetrics patients are at a higher risk of diseases that are common causes of fever in the tropical areas and what the impact is on mothers and their offspring, by pathogens and gestational age. Understanding of this fact is impaired as deaths from infectious diseases and deaths in pregnancy are often not evaluated jointly in public health surveillance.

Methods: This is a retrospective, observational case series undertaken at a tertiary care centre at Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India during the period of January 2011 to December 2015.This data collection was done by reviewing the maternal death record forms.

Results: This study shows that there is significant number (23.58%) of maternal deaths due to infectious diseases. Out of a total of 37266 deliveries over a period of five years, 407 maternal deaths occurred and out of these 96 patients died due to infectious diseases. Among these, deaths due to tuberculosis were seen in 32.29%, hepatitis E 26.04%, pyrexia of unknown origin 9.3%, malaria 8.33%, dengue 6.25%, swine flu 5.2%, leptospirosis 3.12%, and community acquired pneumonia 3.12%, viral encephalitis 2.08%, tuberculosis with HIV 2.08%, amoebiasis and typhoid 1.04% each.

Conclusions: Though India failed to achieve the millennium development goal, it fell short of the goal by a small margin. Educational status and the socioeconomic development are major factors that need to be corrected. Effective preventive strategies at personal and community level will definitely reduce the preventable maternal mortalities due to infectious diseases and aid India in achieving further targets.


Maternal mortality, Infectious diseases

Full Text:



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.

Priddy KD. Immunologic adaptations during pregnancy. J Obstet Gynecol Neonatal Nurs. 1997;26:388.

Styrt B, Sugarman B. Estrogens and infection. Rev Infect Dis. 1991;13:1139-50.

World health organization, media centre. Fact sheet: The top 10 causes of death, 2016. Available at Accessed 12 May 2016.

Press information bureau, government of India, ministry of health and family welfare. Achievements under millennium development goals, 2015. Available at Accessed 11 May 2016.

Ahmed Y, Mwaba P, Chintu C, Grange JM, Ustianowski A, Zumla AA. study of maternal mortality at the University Teaching Hospital, Lusaka, Zambia: the emergence of tuberculosis as a major non-obstetric cause of maternal death. Int J Tuberculosis Lung Diseases. 1999;3(8):675-80.

Mathai M. Jaundice in pregnancy. In: Buckshy, Soonawala, Pathwardhan, eds. Principal and practice of obstetrics and gynaecology for postgraduates and practitioners (FOGSI Publication). New Delhi: Jaypeee Brothers, 1996.

Desai M, Ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, et al. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7(2):93-104.

Monif GRG, Baker DA, editors. Infectious Disease in Obstetrics and Gynecology. 6th ed. New York: Parthenon; 2004:280-286.

World health organization, authors. Guidelines for the treatment of malaria. Geneva: World Health Organization; 2006.

Kiwuwa MS, Mufubenga P. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda. Malar J. 2008;7:44.

Carroll ID, Toovey S, Van Gompel A. Dengue fever and pregnancy - a review and comment. Travel Med Infect Dis. 2007;5:183-8.

Chye JK, Lim CT, Ng KB, Lim JM, George R, Lam SK. Vertical transmission of dengue. Clin Infect Dis 1997;25:1374-7.

Fatimil LE, Mollah AH, Ahmed S, Rahman M. Vertical transmission of dengue: first case report from Bangladesh. Asian J Trop Med Public Health. 2003;34:800-3.

WHO dengue hemorrhagic fever: diagnosis, treatment, prevention and control. 2nd edition. Geneva. 1997. Available at uepublication/en/print.html Accessed 2 November 2009.

Zaba B, Calvert C, Marston M, Isingo R, Nakiyingi-Miiro J, Lutalo T, et al. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: Secondary analyses of pooled community based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). The Lancet. 2013;381(9879):1763-71.

Calvert C, Ronsmans C. HIV and the risk of direct obstetric complications: A systemic review and meta-analysis. PLOS ONE. 2013;12(1):83.

Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: A systemic review and meta-analysis. AIDS. 2013;27(10):1631-9.

Getahun H, Sculier D, Sismanidis C, Grzemska M, Raviglione M. Prevention, diagnosis, and treatment of tuberculosis in children and mothers: Evidence for action for maternal, neonatal, and child health services. Journal of Infectious Diseases. 2012;205:S216-27.

WHO Global Tuberculosis Report. Geneva: WHO 2013. At

Gupta A, Bhosale R, Kinikar A, Gupte N, Bharadwaj R, Kagal A, et al. Maternal tuberculosis: a risk factor for mother to child transmission of Human Immunodeficiency Virus. Journal of Infectious Diseases. 2013;205:S216-27.

Shaked Y, Shpilberg O, Samra D, Samra Y. Leptospirosis in pregnancy and its effect on the fetus: case report and review. Clin Infect Dis. 1993;17:241-3.

Dawood FS, Jain S, Finelli L. Novel swine-origin influenza A (H1N1) virus investigation team, authors. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:2605-15.

Moretti ME, Bar-Oz B, Fried S, Koren G. Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology. 2005;16:216-9.

Centers for disease control and prevention web site, authors. Interim guidance on antiviral recommendations for patients with novel influenza A (H1N1) virus infection and their close contacts. Available at Accessed 24 August 2009.