A study of maternal mortality at the teaching hospital, Hubli, Karnataka

Background: Maternal mortality continues to be a major public health problem in the developing world. Maternal mortality is a vital index of the effectiveness of obstetric services prevailing in a country. The present study was conducted at Karnataka Institute of Medical Sciences, Hubli, which caters to 250 PHC’s/CHC’s and is a major referral centre for 4 districts with an average of 800-1000 deliveries per month. Methods: Data on the maternal deaths at KIMS, Hubli from October 2010 to March 20011 during pregnancy and within 42 days of delivery of any cause, irrespective of the duration and site of pregnancy were collected. Results: The maternal mortality ratio for the study period was per 1,00,000 live births. Among the 40 maternal deaths, 7 deaths (17.5%) occurred in primigravida, 14 deaths (35%) had occurred in primipara, 4 deaths (10%) in gravida 2 and above, 7 deaths (17.5%) in para 2, 5 deaths (12.5%) in para 3 and 3 deaths (7.5%) had occurred in para 4 and above. During the study period, 8 deaths (20%) occurred within 1 hour of admission, 5 deaths (12.5%) within 1-6 hours of admission, 7 deaths (17.5%) between 7-12 hours of admission, 6 deaths (15%) between 13-24 hours, 8 deaths (20%) between 1-2 days and 6 deaths occurred after 2 days of admission. Maternal deaths had occurred mostly in delivered women (75%) compared to undelivered women (25%). During the study period, among the 40 maternal deaths, 34 deaths (85%) occurred due to direct obstetric causes and 6 deaths (15%) due to indirect causes. Among the direct obstetric causes, haemorrhage (30%) and hypertensive disorders of pregnancy (30%) were the leading causes. Pulmonary embolism (10%), rupture uterus (5%), chorioamnionitis (5%), septic abortion (2.5%) and acute inversion of uterus (2.5%) were the other direct causes of maternal deaths. Among the indirect obstetric causes, 4 deaths (10%) occurred due to anaemia which was the leading cause. One death (2.5%) occurred due to cardiac disease and 1 death (2.5%) due to hepatic failure. Conclusions: Reviewing the maternal deaths that occurred in our hospital, there is an urgent need to address the issue of obstetric haemorrhages and early intervention in PIH. Much needs to be done for maternal health care in rural areas as most of the deaths reported from urban institutions are referrals from peripheral centres. Rapid transport facilities should be made available to all remote rural areas with easy accessibility. It is necessary even in urban areas to channel the working of emergency obstetric care. This prevents early intervention and adequate emergency obstetric care. The essential obstetric care for all and early detection of complications and management of emergency obstetric care services need to be seriously looked into. Most maternal deaths are preventable by health education of masses, adequate health care in the community and transport facilities. [Int J Reprod Contracept Obstet Gynecol 2013; 2(1.000): 74-79]