An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa

Objective: To understand the elements influencing the maternal deaths in the Limpopo province, South Africa.Methods: A retrospective review of all maternal deaths which occurred at the Pietersburg Hospital, Limpopo province was done over a five-year period (January 2011 to December 2015). The hospital death register was used to collate a list of maternal deaths occurring during the study period. The medical records of maternal deaths were reviewed. The total deliveries and live births for each year were obtained from the delivery registers. The data collected included maternal age, parity, referring facility, date of admission, date and time of death, ward where death occurred, and cause of death.Results: There were 14 685 live births and 232 maternal deaths between 2011 and 2015, resulting in an institutional Maternal Mortality Ratio (iMMR) of 1579/100 000 live births. The mean age of the patients was 29 years. Forty-three per cent of deaths occurred within 24 hours of admission, 35% died in ICU and 89% were referred from regional and district hospitals and community health centres. Of the referred patients, 83% were from district hospitals. Obstetric haemorrhage and pre-eclampsia, or eclampsia, were the main causes of death.Conclusion: The iMMR at Pietersburg Hospital remains unacceptably high. Most of the maternal deaths are due to obstetric haemorrhage, pre-eclampsia or eclampsia, medical and surgical disorder and non-pregnancy related infections.

Download Full-text

Obstetrical Haemorrhagic Mortality in a Tertiary Hospital of the Limpopo Province, South Africa

Medical Science & Healthcare Practice ◽

10.22158/mshp.v1n1p42 ◽

2017 ◽

Vol 1 (1) ◽

pp. 42

Author(s):

Sam T Ntuli

Keyword(s):

South Africa ◽

Maternal Death ◽

Post Partum ◽

Tertiary Hospital ◽

Limpopo Province ◽

Hospital Death ◽

Maternal Deaths ◽

Obstetric Haemorrhage ◽

District Hospitals ◽

Post Partum Haemorrhage

Background: Obstetric haemorrhage is potentially fatal. Its frequency contributes to assessment of population health. So this study purpose was to assess the maternal deathsdue to obstetric haemorrhage in a tertiary hospital of the Limpopo Province, South Africa. Methods: Allmaternal deaths, which occurred at Pietersburg Hospitalfrom January 2011 to December 2015 were reviewed. The hospital death register was used to collate the list of maternal deaths.Maternalage, parity, referring facility, date of admission and death, ward where death occurred, and causes of deathwere collected from delivery registers and patient medical records.Results: There were 232 maternal deaths of which 48 (20.7%) were due to obstetrical haemorrhage. The mean age of the 48 women was 31.7±6.7 year range 15-48 years. Thirty one of 48 haemorrhagic deaths (65%) occurred within 24 hours of admission, 16 of 48 (33%) had a parity of 3 or more, 19 (40%) died in ICU and 12 (25%) in casualty. Forty three of 48 women (90%) were referred, of which 36 (84%) were from district hospitals. Post-partum haemorrhage accounted for 39 of 48 (81%) deaths followed by unspecifiedante-partum haemorrhage accounting for 4 (8%) and placenta abruption 2 of 48 (4%).Conclusion: This study demonstrated that a maternal death due to obstetric haemorrhage remains a major concern in Limpopo Province. Post-partum haemorrhage was the main cause of deaths.

Download Full-text

Trends on Maternal Mortality in the Republic of Benin and Comparison with the Neighboring Countries

Medicine Law & Society ◽

10.18690/mls.13.2.197-216.2020 ◽

2020 ◽

Vol 13 (2) ◽

pp. 197-216

Author(s):

Romeo Konnon ◽

Said Semyatov ◽

Muhammednazar Soyunov ◽

Zalina Sokhova ◽

Tatevik Zulumyan

Keyword(s):

Maternal Mortality ◽

Maternal Mortality Ratio ◽

High Rate ◽

Maternal Deaths ◽

Live Births ◽

Obstetric Haemorrhage ◽

Mortality Ratio ◽

Republic Of Benin ◽

The Republic ◽

The Government

The maternal mortality ratio in the Republic of Benin in 2015 was still high – 405 per 100,000 live births. The delay in consultation and timely treatment, unavailability of medical facilities and lack of skilled care are the principal factors contributing to maternal deaths in Benin. Consequently, the rate of such preventable causes of maternal deaths like obstetric haemorrhage (38.40 percent and pre-eclampsia/eclampsia (14.30 percent) remains high in the country, and even HIV continued being one of the indirect causes of maternal deaths in 2017 – one percent. High rate of complications associated with pregnancy and birth in adolescent girls is another cause of maternal deaths in the Republic of Benin. Despite the efforts of the Government aimed at improving health care, it is unlikely that we will achieve the United Nations Sustainable Development Goals 3.1. – the reduction of maternal mortality ratio to less than 70 per 100,000 live births by 2030.

Download Full-text

Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182336 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2283

Author(s):

Darshna M. Patel ◽

Mahesh M. Patel ◽

Vandita K. Salat

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Rural Areas ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Care Hospital ◽

Maternal Deaths ◽

Maternal Mortality Rate ◽

Live Births ◽

Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

Download Full-text

GAMBARAN ANGKA KEMATIAN IBU DI RSUP. Prof. Dr. R. D. KANDOU MANADO PERIODE JANUARI 2014 – SEPTEMBER 2015

e-CliniC ◽

10.35790/ecl.4.1.2016.11038 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Ria Mariani Andini ◽

Joice Sondakh ◽

Bismarch J. Laihad

Keyword(s):

Maternal Mortality ◽

Hemorrhagic Stroke ◽

Maternal Mortality Ratio ◽

Sampling Technique ◽

Complex Problem ◽

Health Issues ◽

Maternal Deaths ◽

Live Births ◽

Mortality Ratio ◽

And Child Health

Abstract: Maternal mortality is a complex problem that is caused by a variety of causes that can be distinguished on the determinant of near, intermediate and far. Maternal mortality or maternal death is one indicator to see the progress of the health of a country, especially with regard to maternal and child health issues. The research objective was to determine the description of Maternal Mortality Rate (MMR) in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. Methods: This study is a retrospective descriptive study. The population is all deliveries in RSUP Prof. Dr. dr. R. D. Kandou Manado period January 2014 - September 2015. The samples is 20 persons, sampling with total sampling technique. Results: based on this research, the highest number of births was in 2014 that as many as 3,347 people (70.8%), while in 2015 as many as 1,380 people (29.2%). Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. The number of maternal deaths in the period from January 2014 through September 2015 respectively by 10 people (50%). The most diagnosis entry patients is eclampsia by 10 persons (50.0%) Based on the causes of maternal mortality, that most because of hemorrhagic stroke by 7 people (35.0%).. Conclusion: Maternal Mortality Ratio (MMR) was 298 per 100,000 live births in 2014 and 725 per 100,000 live births in 2015. By entering the patient's diagnosis, most of the patients with the diagnosis of eclampsia and cause most maternal deaths are patients who died because stroke hemorrhagic period January 2014 through September 2015.Keyword: Maternal Mortality RateAbstrak: Kematian ibu merupakan salah satu indikator untuk melihat kemajuan kesehatan suatu negara, khususnya yang berkaitan dengan masalah kesehatan ibu dan anak. Tujuan penelitian adalah mengetahui gambaran Angka Kematian Ibu (AKI) di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Metode: penelitian ini merupakan jenis penelitian deskriptif retrospektif. Populasi yang diambil adalah semua persalinan di RSUP. Prof. Dr. R. D. Kandou Manado Periode Januari 2014 – September 2015. Jumlah sampel adalah 20 orang, penentuan sampel dengan teknik total sampling. Hasil: berdasarkan hasil penelitian, jumlah persalinan terbanyak adalah pada tahun 2014 yaitu sebanyak 3.347 orang (70,8%) sedangkan pada tahun 2015 sebanyak 1.380 orang (29,2%). Rasio Angka Kematian Ibu (AKI) 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015.Sedangkan jumlah Jumlah Kematian Ibu pada periode januari 2014 sampai september 2015 masing-masing sebanyak 10 orang (50%). Diagnosa masuk pasien terbanyak yaitu eklamsia sebesar 10 orang (50,0%) Berdasarkan penyebab kematian ibu, yang tebanyak karena stroke hemoragik sebesar 7 orang (35,0%). Kesimpulan: Rasio Angka Kematian Ibu (AKI) adalah 298 per 100.000 kelahiran hidup pada tahun 2014 dan 725 per 100.000 kelahiran hidup pada tahun 2015. Berdasarkan diagnosis masuk pasien, terbanyak adalah pasien dengan diagnosa eklampsia dan penyebab kematian ibu terbanyak adalah pasien yang meninggal karena stroke hemoragik periode januari 2014 sampai september 2015.Kata kunci: Angka Kematian Ibu

Download Full-text

A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1431 ◽

2016 ◽

Vol 8 (4) ◽

pp. 261-265

Author(s):

Smiti Nanda ◽

Shaveta Yadav

Keyword(s):

Observational Study ◽

Maternal Mortality ◽

Prospective Observational Study ◽

Maternal Mortality Ratio ◽

Near Miss ◽

Maternal Deaths ◽

Live Births ◽

Mortality Index ◽

Severe Maternal Outcome ◽

Mortality Ratio

ABSTRACT Purpose To study the incidence and causes of near-miss cases and maternal deaths (MDs) and also search the level of delay. Materials and methods The prospective observational study was carried out in the Department of Obstetrics and Gynecology for a period of one and a half year (September 2012 to February 2014). For identifying near-miss events, disease-specific criteria were used. Near-miss cases were identified among women with pregnancy-related complications whose diagnoses were meeting the criteria. Detailed information of maternal mortalities and near-miss cases for demographic features, underlying causes, treatment received, and level of delay were also obtained. Results There were 15,170 obstetric admission, 13,851 live births, 184 near-miss cases, and 60 MDs during the study period. The maternal near-miss (MNM) rate was 13.2/1,000 live births and maternal mortality ratio was 433.1/100,000 live births. The mortality index (MD/MNM+MD) was reported as 25%. The maternal mortality to near-miss ratio was 1:3.07. Severe maternal outcome rate (MNM/MNM+MD) was 17.6/1,000 live births. Hemorrhage (54.89%) was the leading cause of nearmiss events followed by hypertension (24.45%) and anemia (13.59%). Hypertension (26.66%) was responsible for most of the MDs followed by anemia (25%), hemorrhage (20%), and puerperal sepsis (10%). The most common level of delay was found on the part of women and/or family to seek help. Conclusion Hypertension, hemorrhage, and anemia are leading causes of maternal morbidity and mortality. Lessons need to be learnt from cases of near-miss, which can serve as a useful tool in making strategies and putting efforts to reduce maternal mortality. How to cite this article Yadav S, Nanda S. A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics. J South Asian Feder Obst Gynae 2016;8(4):261-265.

Download Full-text

Magnitude, Trends and Causes of Maternal Mortality: A 7-year Review at a Tertiary Hospital in Rivers State, Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i130357 ◽

2020 ◽

pp. 103-109

Author(s):

P. A. Awoyesuku ◽

D. A. MacPepple ◽

B. O. Altraide

Keyword(s):

Maternal Mortality ◽

Postpartum Haemorrhage ◽

Maternal Mortality Ratio ◽

Tertiary Hospital ◽

Sub Saharan Africa ◽

Annual Reports ◽

Maternal Deaths ◽

Middle Income ◽

Mortality Ratio ◽

Sub Saharan

Background: Maternal mortality ratios (MMR) are still unacceptably high in many low- and middle-income countries especially in sub-Saharan Africa. Background Data for the causes of maternal deaths are needed to inform policies to improve maternal healthcare and reduce maternal mortality. Objective: This study sought to determine the magnitude and trend in maternal mortality and the causes at a tertiary hospital over a seven-year study period. Methodology: This was a retrospective review of maternal mortality and causes from 2012 to 2018. Data on number of maternal deaths, deliveries and causes of death were retrieved from the departmental annual reports and hospital records and entered into Microsoft Excel 2013. Data were presented as line graphs, charts and frequency tables. Results: One hundred and ten (110) maternal deaths occurred out of 17,080 total births during the study period giving an overall MMR of 644. The MMR increased progressively from 580 in 2012 to 785 in 2018 with a sharp rise to the highest and subsequent decline to the lowest, values at the midpoint. The commonest causes of maternal deaths were Pre-eclampsia (PET) and Eclampsia 44(40%), Postpartum Haemorrhage (PPH) 25(22.7%) and Ruptured Uterus 13(11.8%). Conclusion: The maternal mortality ratio is high and the trend is worsening. The leading causes of maternal deaths were PET/Eclampsia and Postpartum haemorrhage accounting for about two-thirds of all deaths. Efforts must be geared towards improvements in the management of these cases, if this trend is to be reversed.

Download Full-text

Temporal Evolution of Maternal Mortality: 1980-2019

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1735300 ◽

2021 ◽

Vol 43 (09) ◽

pp. 662-668

Author(s):

Janete Vettorazzi ◽

Edimárlei Gonsales Valério ◽

Maria Alexandrina Zanatta ◽

Mariana Hollmann Scheffler ◽

Sergio Hofmeister de Almeida Martins Costa ◽

...

Keyword(s):

Maternal Mortality ◽

Medical Records ◽

Causes Of Death ◽

Maternal Mortality Ratio ◽

Liver Steatosis ◽

Reproductive Age ◽

Porto Alegre ◽

Maternal Deaths ◽

Live Births ◽

Mortality Ratio

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Download Full-text

Maternal mortality and morbidity

10.1093/med/9780198713333.003.0031 ◽

2016 ◽

Author(s):

Suni Halder ◽

Steve Yentis

Keyword(s):

Maternal Mortality ◽

Women’S Health ◽

Women's Health ◽

Maternal Mortality Ratio ◽

Developed Countries ◽

Surveillance Systems ◽

Maternal Deaths ◽

Live Births ◽

The World ◽

Mortality Ratio

The risk to women’s health is increased during pregnancy, and maternal mortality is used as an indicator of general healthcare provision as well as a target for improving women’s health worldwide. Morbidity is more difficult to define than mortality but may also be used to monitor and improve women’s care during and after pregnancy. Despite international efforts to reduce maternal mortality, there remains a wide disparity between the rate of deaths in developed (maternal mortality ratio less than 10–20 per 100,000 live births) and developing (maternal mortality ratio as high as 1000 or more per 100,000 live births in some countries) areas of the world. Similarly, treatable conditions that cause considerable morbidity in developed countries but uncommonly result in maternal death (e.g. pre-eclampsia (pre-eclamptic toxaemia), haemorrhage, and sepsis) continue to be major causes of mortality in developing countries, where appropriate care is hampered by a lack of resources, skilled staff, education, and infrastructure. Surveillance systems that identify and analyse maternal deaths aim to monitor and improve maternal healthcare through education of staff and politicians; the longest-running and most comprehensive of these, the Confidential Enquiries into Maternal Deaths in the United Kingdom, was halted temporarily after the 2006–2008 report but is now active again. Surveillance of maternal morbidity is more difficult but systems also exist for this. The lessons learnt from such programmes are thought to be important drivers for improved maternal outcomes across the world.

Download Full-text

A study to assess proportion of the maternal near miss to maternal death in a tertiary care teaching hospital of North East India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202334 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2486

Author(s):

Pradip Sarkar ◽

Jahar Lal Baidya ◽

Ashis Kumar Rakshit

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Near Miss ◽

Maternal Near Miss ◽

Maternal Deaths ◽

Live Births ◽

Medical Disorders ◽

Mortality Ratio

Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.

Download Full-text

Prevalence and Risk Factors for Maternal Mortality at a Tertiary Care Centre in Eastern Nepal- Retrospective Cross Sectional Study

10.21203/rs.3.rs-226005/v1 ◽

2021 ◽

Author(s):

Sarita Sitaula ◽

Tulasa Basnet ◽

Ajay Agrawal ◽

Tara Manandhar ◽

Dipti Das ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Maternal Mortality ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Type I ◽

Maternal Deaths ◽

Live Births ◽

Contributory Factors ◽

Mortality Ratio

Abstract Background:Maternal mortality ratio is an important public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and to identify the various risk factors and causes of maternal mortality.Methods: This is a retrospective study conducted in a tertiary care center of Eastern Nepal from 16th July,2015 to 15th July 2020. Maternal mortality ratio per 100,000 live-births over 5 years of study period was calculated. The causes of death, delays of maternal mortality and different sociodemographic profiles were analyzed by descriptive statistics.Results:There were total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in year 2015 to 2020. The mean age and gestational age of women having maternal deaths were 24.69 ±5.99 years and 36.15± 4.38 weeks of gestation respectively. The common causes of maternal deaths were obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis. The leading contributory factors to the death were delay in seeking health care and delay in reaching health care facility (type I delay:40.84%).Conclusions:Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors were due to delay in seeking care and delayed referral from other health facilities. Contributory factors related to maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and puerperium.

Download Full-text