Analysis of maternal deaths over a period of three years at a tertiary care centre of Uttarakhand, India
Keywords:Hemorrhage, Maternal mortality, NRHM (National Rural Health Scheme)
Background: Globally, about 800 women die every day of preventable causes related to pregnancy and childbirth; 20 per cent of these women are from India. The study is aimed at evaluating maternal deaths over a period of three years at a tertiary care centre of Dehradun, India.
Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology at SGRRIMHS, Dehradun. The case record files of all maternal deaths from January 2015 to December 2017 was obtained from medical record section of the hospital. Maternal age, parity, educational status, antenatal registration, mode of delivery, admission death interval and causes of each maternal death was noted and analysed statistically.
Results: There were 48 maternal deaths from January 2015 to December 2017.Maximum deaths were in the age group of 21-25 years. The maternal mortality ratio over a period of three years was 671 per one lac live births. Most of the maternal deaths were due to direct causes like hemorrhage , eclampsia followed by sepsis.
Conclusions: Most of the maternal deaths are preventable. High risk cases should be identified at root level and early referral should be the moto. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. To avoid maternal deaths, unwanted and too-early pregnancies should be avoided. All women, including adolescents, should have access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for both the mother and the baby.
WHO. Trends in estimates of maternal mortality ratio (MMR; maternal deaths per 100,000 live births) 1990-2015. Source: WHO, UNICEF, UNFPA, World Bank Group and UNPD (MMEIG). 2015. Available at https://data.unicef.org/topic/maternal-health/maternal-mortality/#
World Health Organization. International statistical classification of diseases and related health problems. Available at http://www.who.int/classifications/icd/en/
Special Bulletin on Maternal Mortality. Government of India. Available at http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf. Accessed 24 Aug 2015.
National Rural Health Mission: Framework for implementation 2005-2012; New Delhi: Ministry of Health and Family Welfare, Government of India. nrhm.gov.in/nhm/nrhm-framework-for-implementation.html.
UN Sustainable Development Goals Available at http://www.un.org/sustainabledevelopment/health/ Accessed on 07 Jan 2017.
Puri A, Yadav I, Jain N. Maternal mortality in an urban care hospital of north India. J Obstet Gynaecol India. 2011;61:280-5.
Jain M, Maharaje S. Maternal mortality: a retrospective analysis of ten years in a tertiary care hospital. Indian J Prev Soc Med. 2003;34:103-11.
Jadhav AJ, Rote PG. Maternal mortality-changing trends. J Obstet Gynaecol India. 2007;57:398-400.
Pal A, Ray P, Hazra S, Mondal TK. Review of changing trends in maternal mortality in a rural medical college in West Bengal. J Obstet Gynecol India. 2005;55:521-4.
Kapadia LD, Lamba AR. Maternal mortality: a tertiary centre panic. Int J Reprod Contracept Obstet Gynecol. 2017;6:3256-9.
Khumanthem PD, Chanam MS, Samjetshabam RD. Maternal mortality and it’s causes in a tertairy centre: J Obstet Gynecol India. 2012;62(2):168-71.
Uma Devi S, Ayesha S, Radha S, Nair ATS, Sulochana KD. Burden and causes of maternal mortality and near miss in a tertiary care centre of Kerala, India. Int J Reprod Contracept Obstet Gynecol. 2017;6:807-13.
Sharma S, Aherwar R, Jawade S .Maternal and fetal outcome in jaundice complicating pregnancy: a prospective study. Int J Reprod Contracept Obstet Gynecol. 2016;5:1084-7.
Ashok V, Santosh M, Anupa S. A study on maternal mortality. J Obstet Gynecol India. 2008;58:227-9.
Guin G, Sahu B, Khare S, Kavishwar A. Trends in maternal mortality and impact of Janani Suraksha Yojana (JSY) on maternal mortality ratio in a tertiary referral hospital. J Obstet Gynaecol India. 2012;62:307-11.
Purandare N, Chandock AS, Upadhya S, Sanjanwala SM, Saraogi RM. Maternal mortality at a referral centre: A five year study. J Obstet Gynecol India. 2007;57:248-5.
Pal SJ, Rao MA. A three-year review of maternal mortality in a district hospital on the west coast in south India (April 2011-2014). Int J Innov Res Dev. 2014;3:15-21.
Patra S, Kumari A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus. Ann Intern Med. 2007;147(1):28-333.