Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study

Sarita Sitaula,Tulasa Basnet,Tara Manandhar,Prezma Shrestha,Dipti Das,Ajay Agrawal

doi:10.1186/s12884-021-03920-4

Sarita Sitaula, Tulasa Basnet + Show 4 more

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https://doi.org/10.1186/s12884-021-03920-4

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Abstract

BackgroundThe maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries.This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality.MethodsThis is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year’s study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics.ResultsThere was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%).ConclusionsDespite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.

Highlights

Maternal mortality is defined as the death of a pregnant women or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidentalThe global maternal mortality ratio showed a significant reduction in maternal deaths from 342 to 211 deaths per 100,000 live births, according to UN inter-agency estimates
The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium
Among 71 maternal death, 65 women had death related to late obstetric events and six deaths were related to early pregnancy complications

Summary

Introduction

Maternal mortality is defined as the death of a pregnant women or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidentalThe global maternal mortality ratio showed a significant reduction in maternal deaths (declined by 38 percent) from 342 to 211 deaths per 100,000 live births (from 2007 to 2017), according to UN inter-agency estimates. 94% of all maternal death has occurred in low and lower middle income countries. The Sustainable Development Goals 3 (SDG 3) plan to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 and have suggested no country should have an MMR greater than 140 per 100,000 live births, a number twice the global target [4]. The Nepal Demographic and Health Survey (NDHS) 2016, have found a decrease in the MMR from 539 to 239 maternal death per 100,000 live births in between 1996 and 2016. The data obtained on maternal mortality from DHIS (District Health Information Software) 2 monthly report of HFS (Health and family services) shows MMR of 114 per 100,000 live-births in year 2016–17. The maternal mortality ratio was calculated per 100,000 live-births over five year’s study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics

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