ANALYSIS OF MATERNAL MORTALITY IN A TERTIARY CARE HOSPITAL TO DETERMINE CAUSES AND PREVENTABLE FACTORS
AbstractBackground: All pregnant women are at risk of obstetrical complications and most of these occur during labour and delivery that lead to maternal death. In our setup maternal mortality is seriously under estimated. Safe motherhood as a priority for action can not be identified with out properly assessing maternal mortality. The objectives of this study were to determine causes and preventable factors responsible for maternal mortality. Methods: This study was conducted in Gynaecology ‘C’ unit of Ayub Teaching Hospital, Abbottabad, from January 2000 to December 2001. Patients were admitted through emergency obstetrics care unit and Gynaecology out patient department. Patients’ demographic record including age, parity, education, socio-economic status along with antenatal care record, level of care and distance from hospital were noted. Causative factors leading to maternal death and contribution factors evaluated. All this information was collected from patients’ records. Results: Twenty-six maternal deaths were recorded during study period. The major causative factors were haemorrhage 9 (34.6%), eclampsia 8 (30%), sepsis 5 (19.2%), anaesthetic complications 3 (11.5%) and hepatic encephalopathy 1 (3.8%). Maternal mortality ratio was 12.7/1000 live births (26/2040). The age range was between 18–42 years. There were 16 (61.5%) patients in >30 years age group. Most of them (69%) were grand multiparas (Parity >5). Education, antenatal booking and socio-economic status were poor. The distance from hospital was between 10 and 100 KM. The level of care available at nearest health facility was estimated, 40% were attended by traditional birth attendants, 33% by lady health visitors, 10% by doctors and to 17% no level of care was available. Conclusion: Obstetrical haemorrhage and hypertensive disorders are still major causes of maternal deaths. Most maternal deaths are preventable. The provision of skilled care and timely management of complications can lower maternal mortality in our setup.Key Words: Maternal mortality, obstetrical complications, preventive measures.
Tinker AG. Improving women’s health in Pakistan. Human Development Network Series. The World Bank, Washington, DC, 1998.
Jafary SN. Maternal Mortality in Pakistan: an overview. Maternal and Prenatal health 1991. TWEL Publication Karachi: 21-31.
National Health Survey of Pakistan. Pakistan medical Research Council, Islamabad, Pakistan 1995.
Women’s health in Pakistan. Fact sheets prepared for Pakistan National Forum on women’s health. WHO November 1997; 14: 3-5.
Annual report of health services of Pakistan. Government of Pakistan Ministry of Health, Islamabad Pakistan 1996.
Schvitemaker NW, Grauenthorst JB, Van Dongen. Maternal mortality and its prevention. Eur J Obs Gynaecol 1999; 42: 531-5.
Drife J. Maternal mortality: National and international perspectives. In: The Yearbook of Obstetrics and Gynaecology. Vol. 8, Shaughn PM, O’Brien (edi). 2000:91.
Maternal mortality. World Health Statistics. WHO Bulletin 1996;29(2).
Jaffery SN. Review of maternal mortality over 10 years period at JPMC, Karachi. J Pak Med Assoc 1972; 22(3):71-6.
Family and reproductive health coverage of maternity care. Society of Obstetrician and Gynaecologists Pakistan. SOGP Survey 1989-90 Pakistan. WHO 1997
Communication report on status of women in Pakistan, 1997.
Iqbal Begum. Analysis of maternal mortality in tertiary care hospital Abbottabad. Pak J Med Res 2000;39(3):107-10.
Knuppel RA, Hatangadi SB. Acute hypertension related to haemorrhage in obstetric patients. Obs Gynecol Clinic North Am 1995;22:111-29.
Duley L. Maternal mortality associated with hypertensive disorders of pregnancy. Br J Obst Gynaecol 1992;99:547-53.
Jaffary SN. Characteristics and practices of traditional birth attendants, a preliminary study. J Pak Med Assoc 1981;31:288-91.
Private Public partnership in health (draft report). Asian Development Bank, TA 2576, Pakistan 1997.
Economic survey 2000-2—1. Economic Advisors Wing, Government of Pakistan, Islamabad Pakistan 2001.
Human development report. United Nations Human Development Program Pakistan. Human Development Profile. 1991; 86-7.
National report for 4th world conference on women at Beijing. Government of Pakistan, Ministry of Women’s Development, Islamabad Pakistan 1995.
Women in Pakistan: an economic and social strategy. World Bank, Washington DC, 1989; PXV.
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