DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184153

Evaluation of preventable causes and risk factors of maternal mortality

Ruby Bhatia, Manjit Kaur Mohi, Neeraj Singh

Abstract


Background: The primary objective was to evaluate preventable causes of maternal deaths at tertiary, second and primary care in Patiala district, Punjab. Secondary objective was to determine impact of socio-demographic characteristics, anemia and three delays on maternal death.

Methods: This is a retrospective observational study carried out between 1. 7. 2013 till 30. 6. 2014, for period of one year in department of a tertiary care hospital and district health authorities catering to secondary and primary care deaths for evaluation of preventable causes and risk factors for maternal deaths at tertiary, secondary and primary level.

Results: A total of 54 maternal deaths with MMR of 170.42/100000 live births, occurred in stipulated period, 87.03% at tertiary care, one at second care, 7.41% at home and 3.7% on the way to tertiary care. Majority of maternal deaths (92.6%) were unbooked, between 21-30 years (64.82%) of age, primi or second gravida (35.18%), para 1 or 2 (37.03%), illiterate (40.74%), low income group (57.41%) with rural background (59.26%). Majority of maternal deaths (77.7%) occurred in postpartum period. Most of maternal deaths (75.93%) were due to direct causes, pre-eclampsia 25.93% followed by sepsis (22.2%) and haemorrhage (20.3%). Anemia was contributory factor in 79.63% maternal deaths. 7.4% maternal deaths occurred at home with delay in seeking care while 29.62% died due to delay in reaching care. In 40.42% maternal deaths, it took more than two hours to reach tertiary care hospital.

Conclusions: Skilled antenatal, intranatal and postnatal care, women empowerment, counseling, early diagnosis and referral of pre-eclampsia and other high-risk cases with curbing anemia at grass root level is need of millennium. Preventing delay in seeking care or reaching care-a step towards sustainable development goals (SDG) to reduce MMR.


Keywords


Anemia, Haemorrhage, Maternal mortality, Preeclampsia, Sepsis

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References


WHO Maternal mortality fact sheet no. 348 (2016). Available at: http://www.who.int/news-room/fact-sheets/detail/maternal-mortality.

Millennium Development Goals India Country Report 2015. Social Statistics Division, Ministry of Statistics and Programme Implementation, Government of India. Available at:

http://mospi.nic.in/sites/default/files/publication_reports/mdg_2july15_1.pdf.

WHO, UNICEF, UNFPA, World Bank Group and United Nations Population Division. Trends in Maternal Mortality; 1990-2015. Available at: https://afro.who.int/sites/default/files/2017-05/trends-in-maternal-mortality-1990-to-2015.pdf.

Vital Statistics division. Ministry of Health and Family Welfare. Registrar General of India, Special Bulletin on Maternal Mortality in India, 2014. Available at: http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR%20Bulletin-2014-16.pdf.

National Rural Health Mission, Maternal Death Review-Mother and Child Health Action Plan 2014-17, Dept. of Health & Family Welfare, Govt. of Punjab. Available at:

http://pbhealth.gov.in/MCH%20ACTION%20PLAN%202014-%2017%20%281%29.pdf.

Maternal Mortality (EPMM) HRP, UNDP, UNFPA, UNICEF, WHO, World Bank, 2015. Available at: www.who.int/reproductive health/topics.

Bemoc Training Gudelines, 2009-10. Ministry of Health & Family Welfare, Government of India. Available at:

http://nhsrcindia.org/sites/default/files/Operational%20Guidelines%20for%20Maternal%20%20Newborn%20Health.pdf.

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

Kausar R. Maternal mortality in India-magnitude cause and concerns. Indian J Pract Doc. 2005;2(2).

Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre‐eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: Int J Obstet Gynaecol. 2014;121:14-24.

Konar H, Chakraborty AB. Maternal mortality: a FOGSI study (based on institutional data). J Obstet Gynaeco India. 2013;63(2):88-95.

Maternal Mortality Fact Sheet (updated November, 2016). Available at: http://www.who.int/news-room/fact-sheets/detail/maternal-mortality.

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 Comm Med: Official Publication Indian Assoc Prevent Social Med. 2011;36(3):213-6.

Sarin AR. Severe anemia of pregnancy, recent experience. Int J Obstet Gynaecol. 1995;50:S45-9.

Barnett S, Nair N, Tripathy P, Borghi J, Rath S, Costello A. A prospective key informant surveillance system to measure maternal mortality–findings from indigenous populations in Jharkhand and Orissa, India. BMC Pregn Childbirth. 2008;8(1):6.