Abstract

Background: Maternal mortality continues to be a major public health problem in the developing world. Maternalmortality is a vital index of the effectiveness of obstetric services prevailing in a country. The present study was conducted at GMC,Kota which is a major  referral centre  with an average of 800-1000 deliveries per month.

Methods: Data on the maternal deaths at GMC, Kota from january 2013 to december 2015 during pregnancy andwithin 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 96 maternaldeaths, 16 deaths (16.66%) occurred in primigravida, 20 deaths (20.83%) had occurred in primipara, 9 deaths (9.37%) in gravida 2, 13 deaths (13.54%) in para 2,13 death(13.54%)  in gravida 3, 16 deaths (16.66%) in para 3 and 9 deaths (9.37%) had occurred in para 4 and above. During the study period, 11 deaths (11.45%) occurred within 1 hour of admission, 28 deaths (29.16%) within 1-6 hours of admission, 12 deaths (12.5%) between 7-12 hours of admission,  19deaths (19.79%) between 13-24 hours, 12 deaths (12.54%) between 1-2 days and 14 deaths(14.58%) occurred after 2 days of admission. Maternal deaths had occurred mostly in delivered women (79.96%) compared to undelivered women (20.83%). During the study period, among the 96 maternal deaths,  78 deaths (81.25%) occurred due to direct obstetric causes and 18 deaths (18.75%) due to indirect causes. Among the direct obstetric causes, haemorrhage (33.33%) and hypertensive disorders of pregnancy (35.41%) were the leading causes. Pulmonary embolism (6.25%), rupture uterus (3.12%), septic abortion (2.08%) and acute inversion of uterus (1.04%) were the other direct causes of maternal deaths. Among the indirect obstetric causes, 13 deaths (13.54%) occurred due to anaemia which was the leading cause. One death (1.04%) occurred due to swine flu and 2 death (2.08%) due to hepatic failure,1 death (1.04%) due to acute myeloid leukemia,1 death(1.04%) due to renal failure.

Conclusions: Reviewing the maternal deaths that occurred in our hospital, there is an urgent need to address the issueof 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.