Ten Year Study of Maternal Mortality at a Teaching Hospital to Assess What More Can be Done

Abstract

Background: Our country has achieved 77% reduction in maternal mortality rate (MMR) over last three decades. Most of the tertiary care institutions record high MMR because they face the influx of women in critical condition needing caesarean deliveries as well as intensive care unit (ICU)-care; thereby increasing the burden of mortality as well as near miss morbidity. The present study is an effort to evaluate the changing needs at the tertiary level of care. Aims and Objectives: Evaluate MMR for the past 10 years, assess causes of death, trend over 10 years against resource up gradation and suggest areas of improvement. Methods: Case records of all maternal deaths over 10 years (2010–2019) at our institute were studied (age, parity, residence, antenatal care booking, causes of death, and admission to death interval). Hospital statistics were obtained for total vaginal births, caesarean sections, high dependency unit–ICU admissions, and resource up gradation over past 10 years. Results: Total live births over 10 year’s period were 106,872 and maternal deaths were 311. Average MMR during 10 years was 291. Maximum deaths occurred in 21–25 years (56.27%), primiparas (58.19%), women from rural areas (68.16%), unbooked/referred cases (91.64%), and postpartum cases (81.67%). Direct causes were responsible for 78.77% and indirect causes for 21.22% deaths. Majority of deaths (80.38%) occurred within 24 h of admission. Conclusion: Upgradation of resources, encouraging early referrals from rural areas, arranging critical care ambulances, and training of manpower in obstetric critical care may bring down MMR at tertiary care hospitals.