Major risk factors leading to maternal mortality in a tertiary care hospital
DOI:
https://doi.org/10.69656/pjp.v16i4.1238Keywords:
maternal mortality, under reporting, near miss, maternal morbidityAbstract
Background: Maternal mortality is a major public health issue in developing countries due to its shocking magnitude and lower declining pattern. In developing countries where 99% of maternal death is occurring, little or no progress has been made. Objective of this study was to identify the underlying causes and factors associated with maternal mortality, and recommendations for quality improvement in maternal and obstetric care. Methods: It was a retrospective individual case review of maternal mortality audit. All cases of maternal death from January 2015 to December 2017 at Sheikh Khalifa Bin Zayed Al Nayhan/Combined Military Hospital Muzaffarabad were reviewed. Results: In the study period 31 maternal deaths were identified in 20,018 live births. Causes were classified as Direct (80.64%), Indirect (6.45%), and Unspecified (12.9%). Major underlying causes were eclampsia (9 cases, 29.03%), obstetric and non-obstetric sepsis (5 cases, 16.13%), antepartum haemorrhage (3 cases, 9.68%), postpartum haemorrhage (3 cases, 9.68%), hepatic encephalopathy (3 cases, 9.68%), and one case each of rupture uterus, abdominal pregnancy, cerebral haemorrhage, bronchial asthma. Four cases were unspecified. Conclusion: Some of the preventable, direct and indirect causes of maternal death have been identified. Recommendations of audit approach helped the hospital team to identify direct and indirect causes of maternal mortality and helped the management to take steps to reduce preventable factors for maternal death.
Pak J Physiol 2020;16(4):6?9
Downloads
References
World Health Organization. Maternal Mortality. 2014. Fact Sheet available at http://www.who.int/mediacentre/factsheets/fs348/en/. [Accessed 1 Dec 2016]
World Health Organization, UNICEF, United Nations Population Fund, World Bank. Trends in maternal mortality: 1990 to 2008 : estimates. Geneva: World Helath Organization; 2010.
Miller S, Belizán JM. The true cost of maternal death: individual tragedy impacts family, community and nations. BMC Reprod Health 2015;12:56.
Prata N, Sreenivas A, Greig F, Walsh J, Potts M. Setting priorities for safe motherhood interventions in resource-scarce settings. Health Policy 2010;94(1):1‒3.
GBD 2015 Maternal Mortality Collaborators. Global regional and national level of maternal mortality, 1990–2015; a systematic analysis for the global burden of disease study 2015. Lancet 2016;388(10053):1775–812.
World Bank: Country income groups World Bank classification. Available at http://www.chartsbin.com/view/2438. [Accessed 1 Dec 2016].
World Health Organization. WHO methods and data sources for country-level causes of death. 2000–2016. 2018.
World Health Organization. WHO Statistical Information System. Available at: http://www.who.int/whosis/en/index.html. [Accessed 1 Dec 2016]
UNICEF. Global Database on Antenatal Care. Available at: http://www.childinfo.org/antenatal care country data.php. [Accessed 1 Dec 2016]
Kodan LR, Verschueren KJC, van Roosmalen J, Kanhai HHH, Bloemenkamp KWM. Maternal mortality audit in Suriname between 2010 and 2014, a reproductive age mortality survey. BMC Pregnancy Childbirth 2017;17(1):275.
Integrated Management of Pregnancy and Childbirth, WHO recommended intervention for improving maternal and newborn health. Geneva: WHO; 2009.
Dumont A, Gaye A, de Bernis L, Chaillet N, Landry A, Delage J, et al. Facility based maternal death review: effect on maternal mortality in a district hospital in Senegal. Bull World Health Organ 2006;84:218–24.
Gebrehiwot Y, Tewolde BT. Improving maternal care in Ethiopia through facility based review of maternal deaths and near misses. Int J Gyn Obst 2014;127(Suppl 1):S29–34.
Hofman JJ, Mohammed H. Experience with facility based maternal death reviews in Northern Nigeria. Int J Gynaecol Obstet 2014;126:111–4.
Dumont A, Tourigny C, Fournier P. Improving obstetric care in low setting: Implementation of facility base maternal death reviews in five pilot hospitals in Senegal. Hum Resour Health 2009;7:61–3.
Hailu S, Enqueselassie F, Berhane Y. Samusel H, Fikre E, Yemane B. Health facility based maternal death in Tigray, Ethopia J Health Dev 2009;23:115–9.
Okong P, Byamugisha J, Mirembe F, Byaruhanga R, Bergstrom S. Audit of severe maternal morbidity in Uganda–implications for quality of obstetric care. Acta Obstet Gynecol Scand 2006;85(7):797–804.
Ronsmans C, Filippi V. Improving obstetric care through near-miss audit. Child Health Dialogue 2000;18:9.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2(6):e323–33.
Center for Sustainable Systems. Social Development Indicators, Factsheet. USA: University of Michigan; 2016.
World Bank. World Development Indicators. 2017. Available at: http://data.worldbank.org/data-catalog/world-development-indicators. [Accessed 1 Dec 2016]
Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study. BMC Public Health 2009;9:462.
Downloads
Published
How to Cite
Issue
Section
License
Pakistan Journal of Physiology, Pak J Physiol, PJP is FREE for research and academic purposes. It can be freely downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.
