Study of causes and facility based lags in a tertiary care hospital contributing to maternal mortality

Background: Maternal death is a tragic situation as these deaths occur during or after a natural process like pregnancy. By addressing the three levels of delays i.e., delay in seeking care, delay in reaching care and delay in receiving care; it can be prevented to a fair extent.Methods: All maternal deaths occurred in SCB Medical College and Hospital, Cuttack between September 2015 to September 2016 included in the study, Antepartum and postpartum events were documented as per the proforma. Opinions of respective faculties regarding diagnosis, treatment, possible preventable factors and any delays and lapses at our set up were obtained.Results: There were 10060 live births and 121 maternal deaths, giving the hospital based incidence of maternal mortality as 12.02 per 1000 live births. 42.98%, 6.61% and 50.41% of death were due to Level I, Level II and level III delays respectively. The delays due to unavailability of appropriate facilities in our institution are highlighted. Lack of ICU facility accounted 37.19% deaths. Unavailability of blood, a delay in surgery, delayed multispecialty referral and required investigation follow it. 91.7%. deaths were preventable.Conclusions: Hypertension, Obstetric hemorrhage, liver and kidney diseases were mainly responsible for maternal mortality. Facility based maternal death review system help in finding out the constraints in the existing system. It brings a sense of responsibility in all stake holders involved in delivery of MCH care. It is feasible and cost effective strategy to reach Millennium Development target 5 in extended time frame