Evaluation of Maternal Mortality Rate (MMR) at a High Volume Tertiary Referral Centre: What are we Missing? A Study Spanning 85,404 Live Births Over 9 Years

Maternal mortality is defined internationally, as maternal death rate per 1, 00, 000 live births. India is among those countries, which has a very high maternal mortality ratio. The current maternal mortality ratio (MMR) in India is 212/100, 000 live births. This study was done to assess maternal mortality in a tertiary medical college hospital situated in semi urban part of coastal Andhra Pradesh. A retrospective hospital based study was carried out in the Obstetrics and Gynecology Department of Government general hospital, Rangaraya Medical College a semi urban tertiary level health care referral centre in Kakinada, Andhra Pradesh, India over a period of 9 years from January 2006 to December 2014. A total 292 maternal deaths were analyzed. The mean maternal mortality rate in the study period was 341.90/100000 live births. Maximum maternal deaths (60.9 %) were reported in the age group of 20 to 24 years. However a significant number of deaths (12.3 %) occurred in teenage pregnancies. More deaths were reported in multiparous women (54.8 %) as compared to Primiparas. (45.2 %), more maternal deaths were reported in women from rural areas (80.4 %) as compared to women from urban areas (19.6 %). Maximum maternal deaths were reported in un booked patients (66.8 %) as compared to booked patients (33.2 %). The classical triad of eclampsia (47.5 %), hemorrhage (28.9 %), and sepsis (23.4 %) was the major direct causes of maternal deaths. Anemia, jaundice, heart disease and malaria accounted for 15.5 %, 22.9 %, 21.1 % and 7.3 %of indirect maternal deaths respectively.