DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184229

Trends in causes of maternal mortality in a tertiary care centre in Kerala, India

Sreekumari U., Shilpa Nair

Abstract


Background: Kerala has the lowest maternal mortality ratio compared to other Indian states. But when compared to developed countries Kerala has still a long way to go. The present study aimed to analyse the causes of maternal deaths that occurred in the study setting for a period of seven years (2011-2017).

Methods: Retrospective study which was conducted at SAT hospital, Govt. Medical College, Thiruvananthapuram. All maternal deaths that occurred in the study setting from January 2011 to December 2017 were found out from registers. The baseline socio demographic characteristics, gravidity, parity, cause of death were recorded using structured proforma and analyzed using SPSS software.

Results: Total maternal deaths during the time period was 101. There were 66441 live births. Maternal mortality ratio for the seven-year period was 152. Majority were primigravidae (50.49%), of low socio-economic status (79.2%), rural population (81.1%) and referred from periphery after identifying complication (85.1%). Caessarean section was the commonest mode of delivery among them (43.56%). Regarding cause of death, indirect maternal deaths were more than direct deaths (50.49% versus 42.57%). Cardiac disorder was the leading indirect cause (12.87%), Post-partum hemorrhage (13.86%), Hypertensive disorders (8.91%) and Sepsis (7.9%) were the leading direct causes.

Conclusions: Early referral protocols, increasing blood and blood component availability in the periphery should be reinforced. Regarding indirect causes medical boards should be constituted in tertiary care centres for prompt and efficient multidisciplinary care.


Keywords


Direct maternal deaths, Indirect maternal deaths, Maternal mortality

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References


World Health Organization. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Lewis G - British medical bulletin, 2003 - academic.oup.com. Available at: https://academic.oup.com/bmb/article/67/1/27/330383.

World Health Organization (WHO). International statistical classification of diseases and related health problems. 10th Revision. Volume 2. Instruction manual. 2010 ed. Geneva: WHO; 2011. Available at: www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf.

WHO U. UNFPA, The World Bank and the United Nations Population Division. Trends in maternal mortality. 1990;2013:1-68. Available at: www.who.int/reproductivehealth/publications/monitoring/maternal-mortality.../en/.

Ramachandran P. Millennium development goals (MDG): India’s progress and way forward to sustainable development goals. Proceedings of the Indian National Science Academy. 2016;82(5):1351-65.

Idoko P, Anyanwu MO, Bass S. A retrospective analysis of trends in maternal mortality in a Gambian tertiary health centre. BMC Research Notes. 2017;10(1):493.

Chandran JR, Raj SV, Ramachandran A. Maternal near miss review from a tertiary care center in South India. Int J Reprod Contracept Obstet Gynecol. 2017;5(8):2657-60.

Sundari KM, Jayanthi RD, Ramasamy B. Trends in maternal mortality in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2016;5(11):3659-62.

Mediratta G, Khullar H, Bhandari SK. An observational study of maternal mortality in a tertiary care hospital in New Delhi. J Indian Acad Clini Med. 2015;16(2).

El Arifeen S, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK. Maternal mortality in Bangladesh: a Countdown to 2015 country Khandale SN, Kedar K. Analysis of maternal mortality: a retrospective study at tertiary care centre. Lancet. 2014;384(9951):1366-74.

Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ. Saving lives, improving mothers' care: Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland. Confidential enquiries into maternal deaths and morbidity 2009-13. Available at: https://www.npeu.ox.ac.uk/mbrrace-uk/reports.

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.

Paily VP, Ambujam K, Rajasekharan Nair V, Thomas B. Confidential review of maternal deaths in Kerala: a country case study. BJOG: Int J Obstet Gynaecol. 2014;121:61-6.

Goli S, Jaleel AC. What is the cause of the decline in maternal mortality in India? Evidence from time series and cross-sectional analyses. J Biosoc Sci. 2014;46(3):351-65.

Jain AK. Janani Suraksha Yojana and the maternal mortality ratio. Eco Political Weekly. 2010;45(11):15-6.

Sundari KM, Priya RP. Maternal mortality: analysis of causes and preventable factors. Int J Reprod Contracept Obstet Gynecol. 2017;5(6):1719-21.

Garg P. To study maternal mortality and complications leading to maternal death in the tertiary care centre. Int J Med Res Rev. 2016;4(3):347-52.

Khandale SN, Kedar K. Analysis of maternal mortality: a retrospective study at tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6(4):1610-3.

Patel DM, Patel MM, Salat VK. Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India. Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2283-6.

Khumanthem PD, Chanam MS, Samjetshabam RD. Maternal mortality and its causes in a tertiary center. J Obstet Gynecol India. 2012;62(2):168-71.

Puri A, Yadav I, Jain N. Maternal mortality in an urban tertiary care hospital of North India. J Obstet Gynecol India. 2011;61(3):280.

Narlawar UW, Lilare RR, Nisal K. A comparative study on maternal mortality at government medical college, Nagpur. Indian J Appl Res. 2018;8(1).