MATERNAL MORTALITY IN A TERTIARY CARE HOSPITAL: A 3-YEAR REVIEW

Motherhood is associated with multiple health risks, including maternal mortality remaining a major global public health concern, particularly in Empowered Action Group states of India, which continue to report higher levels of maternal mortality ratio. The present study aimed to analyze the clinical etiology, and systemic factors contributing in maternal deaths at a tertiary referral center of Madhya Pradesh, a state persistently elevated MMR. All recorded and reported maternal deaths (n=35) over a 3-years period were subjected to retrospective descriptive analysis. Data was extracted from institutional maternal death review registers and clinical records, including demographic features, antenatal care exposure and the immediate causes of deaths. Most of the maternal deaths (82.8%) were seen in the age group 20–29 years, and 91.4% belonged to rural backgrounds. Only 37.1% of cases were booked for antenatal care, thus highlighting the apparent deficiency in antenatal coverage. The postpartum period emerged as the highest risk phase, accounting for 60% of maternal deaths. Hypertensive diseases of pregnancy (Eclampsia) were the most common direct cause of death (42.9%), followed by obstetric haemorrhage (22.8%) and sepsis (20%). Severe anaemia was a ubiquitous indirect contributing factor, present in 68.6% of cases. The high institutional MMR is representative of role of the study centre as a tertiary "safety net" center for critically ill, unbooked rural referrals from rural and peripheral health facilities. The reduction of the "Three Delays" especially delays in receiving appropriate care, and alongside strengthening community  based detection and management of anemia and eclampsia, is essential for reducing maternal mortality in this setting.