Study of changing trends and patterns in maternal mortality at a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251242Keywords:
Maternal mortality ratio, Tertiary care, Hypertensive disorders, Maternal health, Referral system, Antenatal careAbstract
Background: Maternal mortality continues to be a critical indicator of healthcare quality and socioeconomic development, particularly in developing nations. This study analyzes the evolving trends and patterns of maternal deaths at Karnataka institute of medical sciences (KIMS), Hubli, a major tertiary care center serving multiple districts in North Karnataka.
Methods: This cross-sectional observational study combined retrospective and prospective approaches to analyze maternal deaths at the department of obstetrics and gynecology, KIMS, Hubli, from 2019 to 2023. Medical records were reviewed for all maternal deaths occurring within 42 days of pregnancy termination, including complications from pregnancy, labor, puerperium, and related interventions. Data analysis encompassed maternal age, parity, antenatal registration, delivery characteristics, admission-to-death interval, and cause of death. Statistical analysis was performed using proportions and means to establish patterns and correlations in the collected data.
Results: A five-year analysis (2019-2023) at KIMS, Hubli documented 277 maternal deaths among 51,683 live births, yielding an average maternal mortality ratio (MMR) of 542.68 per 100,000 live births. The MMR peaked during 2021 (733.06) and subsequently declined to 437.46 in 2023. The majority of deaths occurred in women aged 20-25 years (53.79%) and primigravidas (57.03%), with hypertensive disorders (53.3%) being the leading direct cause of death. Notable trends included an increase in facility bookings (2.7% to 17.64%), a decrease in referred cases (100% to 70.5%), and a shift from vaginal deliveries (56.7% to 27.4%) to cesarean sections (32.4% to 52.9%). The COVID-19 pandemic's impact was evident through increased indirect causes of death during 2020-2021, with pneumonia/COVID accounting for 36.4% of indirect deaths across the study period.
Conclusions: The study revealed critical gaps in peripheral healthcare services and emphasized the need for strengthening antenatal care at primary healthcare centers. The high proportion of preventable causes highlights the importance of early detection, timely referral, and enhanced critical care capabilities in reducing maternal mortality.
Metrics
References
World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
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. DOI: https://doi.org/10.1016/S2214-109X(14)70227-X
Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of maternal and foetal outcomes in pregnancies complicated with hypertension. J Clin Diagn Res. 2017;11(7):QC01-5.
Kassebaum NJ, Barber RM, Bhutta ZA, Dandona L, Gething PW, Hay SI, et al. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1775-812. DOI: https://doi.org/10.1016/S0140-6736(16)31470-2
Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, et al. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388(10056):2164-75. DOI: https://doi.org/10.1016/S0140-6736(16)31533-1
Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-74. DOI: https://doi.org/10.1016/S0140-6736(15)00838-7
Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, et al. The scale, scope, coverage, and capability of childbirth care. Lancet. 2016;388(10056):2193-208. DOI: https://doi.org/10.1016/S0140-6736(16)31528-8
United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations. 2015.
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. DOI: https://doi.org/10.1016/S0140-6736(13)60686-8
Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388(10056):2176-92. DOI: https://doi.org/10.1016/S0140-6736(16)31472-6
Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(6):e759-72. DOI: https://doi.org/10.1016/S2214-109X(21)00079-6
Mittal P, Kapoor G, Kumari N, Bajaj B. Review of Maternal Mortality at a Tertiary Care Hospital: What Have we Achieved? J Obstet Gynaecol India. 2019;69(2):149-154. DOI: https://doi.org/10.1007/s13224-018-1129-1
Thaker RV, Tyagi AA, Makwana NM, Patel FP. Prevalence and causes of maternal mortality at a tertiary care teaching hospital in Western India. Int J Adv Biol Med Sci. 2022;24:3831.
Verma A, Choudhary R, Chaudhary R, Kashyap M. Maternal Near-Miss and Maternal Mortality in a Tertiary Care Center of Western Uttar Pradesh: A Retrospective Study. Cureus. 2023;15(7):e42697. DOI: https://doi.org/10.7759/cureus.42697
Khandale SN, Kedar K. Managing postpartum anemia with ferric carboxymaltose at tertiary level hospital: a retrospective study. J Evolution Med Dental Sci. 2015;4(44):7580-6. DOI: https://doi.org/10.14260/jemds/2015/1101
Downloads
Published
How to Cite
Issue
Section
