Critical analysis of maternal deaths from sepsis in a tertiary care center and lessons learned

Background: Maternal mortality in India is reported to be 300 to 500 per 100,000 births in the Bulletin of World Health Organisation. It is far away from Millennium development goal 5 where it is required to reduce MMR to 109 per 100, 000 live births. Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Aim: It was to critically analyze all the mothers who died due to sepsis in order to identify factors associated with deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died due to sepsis were included in the study and they were all analyzed modelled on the United Kingdom Confidential Enquiries into maternal deaths. Results: During the study period there were 44 total maternal deaths out of 5863 births giving maternal mortality ratio of 641 per 100,000 maternities. Out of 44 maternal deaths, 14 were due to sepsis making it the leading cause of maternal mortality in our institute. Out of fourteen deaths due to sepsis nine were due to direct causes and the remaining five were due to indirect causes such as pneumonia, sickle cell disease with malaria, and pancytopenia. The ages of the women who died ranged from 19 to 38 years with a median age of 26 years. All had normal body mass index. Five women who died were tribals, six from rural areas and the remaining three from slums of urban areas. Eight women were primigravid. Eight women died from sepsis in the antenatal period, two deaths were in the first trimester after criminal abortion, three due to pneumonia, one had intrauterine dead fetus infected and the other was due to pancytopenia. Four deaths were due to genital tract sepsis after cesarean section and two were due to genital tract sepsis after normal delivery. These six had risk factors such as anemia, prolonged rupture of membranes etc. Conclusion: In few cases, the outcome was inevitable, but for majority it might have been different had the infection been diagnosed and treated more promptly. There are lessons learned from the deaths of these women to improve the survival of mothers and to achieve millennium development goal 5.