A Retrospective Study of Maternal Mortality in a Tertiary Care Hospital

Background: Maternal mortality in developing countries is twenty times greater than that of developed countries according to WHO. It is a strong indicator for measuring the women health care. Most of the maternal deaths are preventable with prompt medical care. Aim: To study the factors causing maternal mortality in a tertiary care teaching hospital for four years period from 2016 January to 2019 December. Methodology: The present study is a retrospective hospital based study done in a tertiary care teaching hospital King George Hospital in Andhra Pradesh, a state in southern India. King George hospital is multidisciplinary teaching hospital serves about 9,000 to 10,000 pregnant women annually with majority of high risk pregnancies. The data is collected from the hospital medical records. The study included all maternal deaths of delivered and undelivered, miscarriages, MTPs, Ectopic pregnancy and also medical disorders complicating pregnancy. Exclusion criteria include the cases of brought dead mothers, maternal deaths due to accidents and suicides. Results: The total number of maternal deaths are 160 in a period of four years. Majority of maternal deaths are unbooked (87.5%). Only 12.5% maternal deaths were booked. 56.5% of the maternal deaths occurred in the age group of 21 to 25 years. Majority (57.5%) of maternal deaths occurred in multigravida. Antenatal deaths constituted 32.5% of total maternal deaths. 54.9% were post natal deaths. 13.75% of maternal deaths due to illegal MTP outside the hospital and ruptured ectopic pregnancy. 57% of the maternal deaths were seen in first 48 hours of delivery. 34.8% of maternal deaths were between 2 to 7 days of delivery. 32.5% of maternal deaths occurred within 24 hrs of admission. Out of 160 maternal deaths, 120 (75%) deaths are due to direct causes. Remaining 40 (25%) maternal deaths contributed for Indirect Obstetric causes. Of all the direct obstetric causes haemorrhage both antepartum and post-partum haemorrhage which accounts for 27% of the maternal deaths, 23% accounted for Preeclampsia and Eclampsia and another 23% from sepsis. Heart disease, anaemia, dengue fever, viral hepatits, pulmonary embolism were the indirect obstetric causes of death. Conclusion: Most of the maternal deaths are due to unidentified high risk pregnancies and delayed referral to the higher centers. Health services need to be upgraded at all the levels of health care centers. The triad of haemorrhage, hypertension and sepsis are still occupying the important obstetric causes of death. Obstetric haemorrhage is still one of major causes of deaths indicates the need for blood transfusion facilities even at first referral unit. Early detection and referring the high risk antenatal women to tertiary care centers is to be encouraged