scholarly journals EVALUATE THE DIRECT AND INDIRECT ETIOLOGIES OF MATERNAL MORTALITY: A RETROSPECTIVE ANALYSIS.

Author(s):  
Rashmi Kumari ◽  
Usha Kumari ◽  
Krishna Sinha

Aim: prevalence and the various direct and indirect etiologies of maternal mortality. Materials and Methods: The present 1 years retrospective hospital based study was conducted in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur,Bihar,India Results: A total of 56 deaths were analyzed. The mortality rate in study period was 333 per 1,00,000 live births. Maximum maternal deaths (60.7%) were reported in the age group 21-25 years. More deaths were reported in multiparous women (67.9%) as compared to primiparous women (32.1%). Most of them were unbooked cases (60%). Hemorrhage (30.4%), eclampsia (16.1%), sepsis (12.5%) and embolism (7.1%) were the major direct causes of maternal death. Anemia (16.1%) was the major indirect cause of death. Conclusions: Hemorrhage is the leading cause of maternal death followed by hypertensive disorders and sepsis. Anemia continues to be the most common indirect cause. Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre. Keywords: MMR, Hemorrhage, Sepsis, Anemia

Author(s):  
Sweety Rani ◽  
Abha Rani Sinha

Aim: to assess the existing MMR and the causes of maternal mortality. Materials and Methods: The present retrospective hospital based study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar from Jan 2017 to march 2018. Results: A total of 56 deaths were analyzed. The mortality rate in study period was 333 per 1,00,000 live births. Maximum maternal deaths (60.7%) were reported in the age group 21-25 years. More deaths were reported in multiparous women (67.9%) as compared to primiparous women (32.1%). Most of them were unbooked cases (60%). Hemorrhage (30.4%), eclampsia (16.1%), sepsis (12.5%) and embolism (7.1%) were the major direct causes of maternal death. Anemia (16.1%) was the major indirect cause of death. Conclusions: Hemorrhage is the leading cause of maternal death followed by hypertensive disorders and sepsis. Anemia continues to be the most common indirect cause. Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre. Keywords: MMR, Hemorrhage, Sepsis, Anemia


Author(s):  
Jayasree Hansda ◽  
Debobroto Roy ◽  
Krishnapada Das ◽  
Manojit Sarkar ◽  
Rumpa Das ◽  
...  

Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.


Author(s):  
Usha Doddamani ◽  
Nirmala Rampure ◽  
Kaveri . ◽  
Pooja .

Background: Maternal mortality is a strong indicator for measuring the health care provided to the women by any society. Motherhood is an event of joy and celebrations for every family. It is tragic that deaths occur during pregnancy and childbirth and most are preventable. The aim is to study the incidence of maternal mortality, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital based study was conducted in the Department of OBG, Gulbarga Institute of Medical Sciences, a tertiary level health care referral centre in Kalaburgi, Karnataka, India over a period of 2 years from January, 2016 to December, 2017.Results: A total of 65 deaths were analysed. The mortality rate in study period was 364 per 1,00,000 live births. Maximum maternal deaths were reported in the age group 20-24 years. More deaths were reported in multiparous women (55.8%) as compared to primiparous women (44.2%). Most of them were unbooked cases (60%). The classic triad of haemorrhage (38.4%), hypertensive disorders (29.2%) and sepsis (12%) were the major direct causes of maternal death. Anemia was the major indirect cause of death. Other indirect causes of maternal death were jaundice, heart disease, respiratory disease and epilepsy.Conclusions: Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre.


Author(s):  
Prachi Sarin Sethi ◽  
Sujata Sharma ◽  
Indu Chawla

Background: The World Health Organization (WHO) estimates that, of 536,000 maternal deaths occurring globally each year, 136,000 take places in India. Maternal death has serious implications to the family, the society and the nation. It deprives the surviving infant of mother's care. This study was done to assess maternal mortality in a tertiary care centre in north India where large numbers of patients are referred from the peripheral centers and the rural parts. This study was done to assess the causes of maternal mortality and suggest remedial measures to reduce the same. Objective of present study was to assess the causes of maternal death over a period of one year at G.M.C Amritsar, India.Methods: A retrospective hospital based study of 22 maternal deaths over a period of 1 year from June 2012 to June 2013. The information regarding demographic profile and reproductive parameters were collected and results were analyzed.Results: Over the study period, there were 22 deaths and 7272 live births (Majority were referral from other districts all over Punjab). Most common direct cause of maternal mortality was haemorrhage and anemia was the most common indirect cause. Most maternal deaths were seen in patients from rural areas, unbooked, illiterate patients and patients from low socioeconomic status.Conclusions: Proper health education should be given to the women; early registration of antenatal cases should be done which allows for rapid diagnosis and treatment of high risk cases. Also constructing a well equipped health care facility with trained staff and prompt transport facilities for early referral can bring down the maternal mortality rate in our country.


Author(s):  
Ranu Jain ◽  
Mamta K. Shewte

Background: Rupture of a previously unscarred uterus is usually a catastrophic event resulting in death of the baby and sometimes even maternal death from blood loss. Incidence of rupture uterus varies from 0.3/1000 to 7/1000 deliveries in India accounting for 5% to 10% of all maternal deaths. Hence, the present study was conducted to study the proportion of ruptured uterus among the antenatal women admitted, their associated clinical spectrum and maternal outcome.Methods: A cross sectional study was carried out among 46 antenatal women presented with ruptured uterus in the department of Obstetrics and Gynaecology at N.S.C.B medical college and Hospital at Jabalpur, (M.P) during 1st August 2011 to 31st August 2012.Results: The incidence of ruptured uterus was 1 in 118 (0.84%) of all hospital deliveries. Mostly, 18 (39.1%) patients were in 26 -30yrs of age. Maximum, 22 patients (47.83%) with ruptured uterus were in second gravidae. Most common site of scar rupture was lower uterine segment, observed in 42 (91.30%) patients. The most common form of management was rent repair done in 36 (78.26%) patients, followed by subtotal hysterectomy (STH) in 8 (17.39%) and total hysterectomy (TH) in 2(4.34%) patients. A perinatal mortality was seen in 38 (82.60 %) cases with 1 maternal death was observed.Conclusions: Reducing the primary cesarean section rate and early diagnosis with active surgical management will go a long way in reducing the incidence of ruptured uterus and maternal and fetal mortality.


Author(s):  
Anjan Dasgupta ◽  
Abirbhab Pal ◽  
Nikita . ◽  
Debanjana Dasgupta ◽  
Partha Ghosh

Background: The estimates of maternal mortality can only be used as a rough indicator of maternal health situation in any given country. High maternal mortality reflects not only in inadequacy of health care services for mothers, but also a low standard of living and socio economic status of the community. Objective was to assess the maternal mortality ratio (MMR), its probable causes and changing trends.Methods: The present study conducted at Midnapore Medical College (MMC), West Bengal. Data for analysis were collected from medical college record section and maternal death registrar book after having permission from higher authority of the college during the period from January 2009 to 2018 December. Total sample size for this period was 249. Statistical analysis was done through SPSS software.Results: Ten years data analysis of 249 subjects showed that total live births from January 2009 to December 2018 was 1,39,126 with MMR 178.97%. Hypertensive disorder of pregnancy (40.56%) was the leading direct cause of maternal death followed by hemorrhage (24.49%) and septicemia (10.84%). Heart disease (6.42%) was the major indirect cause of death followed by anemia (3.6%). Maternal death rate found high among primi gravida (59.43%) mothers and within 20 years age group (46.18%).Conclusions: Most maternal deaths are preventable by proper antenatal care, early diagnosis of high risk factors, timely referral to tertiary care centre along with community upliftment especially in rural and tribal based population. 


Author(s):  
Shobha G. ◽  
Jayashree V. Kanavi ◽  
Veena B. Divater ◽  
Annamma Thomas

Background: The objectives of this study were to calculate the maternal mortality ratio, causes for maternal death in our institution and the duration of hospital admission to death interval.Methods: The study included collecting and analyzing the details of maternal death in women who were admitted to St. Johns Medical College Hospital, Bengaluru, from January 2007 to December 2016. Results: Total maternal deaths were 61 and live births were 26,001 during the study period. The maternal mortality ratio (MMR) was 234.6 per 100,000 live births. Majority of maternal deaths occurred in women aged 18 - 35 years 56 (91.80%) women, primipara 45 (73.77%) and referred cases to our institution from other hospitals 52 (85.24%).                      Most of the women died in the postnatal period 54 (88.52%). Direct obstetric causes accounted for 44 (72.13%) maternal deaths and indirect causes 17 (27.86%) deaths. Preeclampsia and eclampsia were the leading causes for death 13 (21.31%) followed by acute fatty liver of pregnancy 12 (19.67%), hemorrhage 7 (13.11%) and sepsis 6 (9.83%). Anemia was present in 77.04% of women at the time of admission to our hospital. Thirty six (59.01%) women died within a week of admission to the hospital, in which 13 (21.31%) women died in less than 24hours of admission. Twenty five (40.98%) women died after a week of admission to hospital.Conclusions: Apart from the triad of preeclampsia, obstetric haemorrhage and sepsis, acute fatty liver of pregnancy has emerged as an important cause of maternal death. Most of the maternal deaths are preventable. Early detection of complications and timely referral to tertiary care hospital in St. Johns Medical College Hospital, Bengaluru, Karnataka, India decreases maternal morbidity and mortality.


Author(s):  
Surekha N. Khandale ◽  
Kshama Kedar

Background: Mother is the pillar of the family and maternal deaths during pregnancy and delivery are great loss to baby, family, society and country too. Epidemiological data pertaining to maternal mortality is valuable in each set-up to design interventional programs to reduce the ratio favourably. This study was design to evaluate the mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, types of delay, and to suggest recommendations for improvement. Aim of the study was to analyse the causes of maternal death at tertiary care centre. Objective of the study was to analyse causes of maternal death and type of delay, and to suggest measures to reduce it.Methods: A retrospective study done at a tertiary level care centre from January 2011 to June15. Demographic data and other data were collected from maternal death review forms and case records. Data studied and analysed.Results: Most maternal deaths were due to obstetric causes like eclampsia (16.66%), preeclampsia (11.53%), anaemia (14.10%)and haemorrhage (10.25%). Associated co-morbid medical conditions hepatitis (6.41%) and heart disease (5.12%) were in the top list. Majority women were from rural area (69.23%), belonged to below poverty line (76.92%), had less than three visits (64.09%), received care at periphery below the level of specialist sub-district hospital. 94.87%were referred, and travelled more than 4 hours to reach hospital (88.44%). In majority cases Type 1 delay was most common (85.89%) comparatively to Type 2 and 3 delay.Conclusions: High risk cases should be identified. Early referral, easy transport, continued skill based training, monitoring of health services can reduce maternal mortality. Special training should be conducted for ASHA workers and ANM who generally works at grass root level in our country. Continued medical training is required for medical officers who are working at PHC and sub district hospital for early recognition of high risk women and their referral in time to higher centers to avoid maternal near miss or death.


Author(s):  
Kalpana Yadav ◽  
Neelu Rajput ◽  
Arti Tiwari ◽  
Gunjan Yadav

Background: Maternal mortality is one of the important indicators used for the measurement of maternal health. The present study was conducted to analyse the maternal deaths over a period of five years in a tertiary care centre, GMH Rewa, Madhya Pradesh.Methods: A retrospective observational   study was conducted in department of Obstetrics and Gynaecology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa. The case records of all maternal deaths between January 3013 to December 2017 were collected from hospital medical records and studied. Data were analyzed statistically.Results: There were 214 maternal deaths from January 3013 to December 2017.The average maternal mortality ratio over a period of five years was 471.5 per one lac live births. Majority of maternal deaths were from toxaemia 33.2%, haemorrhage 26.2%, anaemia 16.3% and sepsis 12.6%.Conclusions: The present study highlights the importance of early antenatal registration of all pregnancies and regular follow up of cases by trained staff. Active management of high-risk groups by frequent antenatal visits, fluid and component transfusions, aggressive management of infection and closer monitoring of women in labor. Higher fertility and unwanted pregnancies should be reduced through family welfare services and easy availability of Medical termination of pregnancy services to be ensured. Analysis of every maternal death through maternal death audit should be carried out. 


1970 ◽  
Vol 8 (2) ◽  
pp. 222-226 ◽  
Author(s):  
NS Shrestha ◽  
R Saha ◽  
C Karki

Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity; Maternal mortality; Five factor scoring system DOI: 10.3126/kumj.v8i2.3563 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 222-226


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