Analysis Maternal mortality in a tertiary care hospital to determine causes and preventable factors

All pregnant women are at risk of obstetrical complications and most of these occur during labor and delivery that lead to maternal death. In our setup maternal mortality is seriously under estimated. Safe motherhood as a priority for action can not be identified with out properly assessing maternal mortality. The objectives of this study were to determine causes and preventable factors responsible for maternal mortality. This study was conducted in Gynaecology 'C' unit of Ayub Teaching Hospital, Abbottabad, from January 2000 to December 2001. Patients were admitted through emergency obstetrics care unit and Gynaecology out patient department. Patients' demographic record including age, parity, education, socio-economic status along with antenatal care record, level of care and distance from hospital were noted. Causative factors leading to maternal death and contribution factors evaluated. All this information was collected from patients records. Twenty-six maternal deaths were recorded during study period. The major causative factors were haemorrhage 9 [34.6%], eclampsia 8 [30%], sepsis 5 [19.2%], anaesthetic complications 3 [11.5%] and hepatic encephalopathy 1 [3.8%]. Maternal mortality ratio was 12.7/1000 live births [26/2040]. The age range was between 18'42 years. There were 16 [61.5%] patients in >30 years age group. Most of them [69%] were grand multiparas [Parity >5]. Education, antenatal booking and socio-economic status were poor. The distance from hospital was between 10 and 100 KM. The level of care available at nearest health facility was estimated, 40% were attended by traditional birth attendants, 33% by lady health visitors, 10% by doctors and to 17% no level of care was available. Obstetrical haemorrhage and hypertensive disorders are still major causes of maternal deaths. Most maternal deaths are preventable. The provision of skilled care and timely management of complications can lower maternal mortality in our setup

Analysis of maternal mortality in a tertiary care hospital abbottabad

Analysis of 37 maternal deaths, which occurred in unit A of Women and Children Hospital, Abbottabad during a four year period from 1994-1997 was carried out. During this period there were 4452 deliveries, and 4073 live births. Thus the materrial mortality ratio was 9.46/1000 live births. The main cause of death being hemorrhage 27%, eclampsia 24.4%. Advance age increases the risk of child bearing and in our study 23 patients were not in the safest age group [safe age group 21-29 years]. Seventeen patients [45.9%] were associated with high parity. All patients were admitted in emergency, with none of them having received any ante-natal advice previously. 34 were admitted in serious condition, while one was in apparently stable condition. It is concluded the majority of maternal death in this series occurred due to lack of ante-natal care. Trained TBA's are advised to be included in prenatal care

Management of second degree uterovaginal prolapse

Uterovaginal prolapse, though not a life threatening disease, can greatly affect the quality of majority of women especially during their menopausal period. Hysterectomy, vaginal or abdominal is usually the treatment of choice. Lefort's operation is sometimes advocated for severe prolapse in elderly women and for vaginal inversion after hysterectomy. It can also be performed under local anaesthesia if needed

Indication and outcome of forceps deliveries in a teaching hospital

Of 2811 deliveries between 1st January 1992 to 31st December 1992 in Gynae A Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, forceps deliveries were 277 [incidence - 9.85%]. The incidence of failed forceps was 2.16%. The most common group of indications were abnormalities of 2nd stage [53.09%]. There were 31 still births and 12 neonatal deaths. The total perinatal deaths were 43. The commonest cause of still birth was birth asphyxia. Most of neonatal deaths were due to prematurity. The perinatal deaths were in cases with pre-existing maternal, obstetrical and fetal complications; 60 of our patients had one or other type of complication. The maternal mortality rate was 1.44%, forceps not being the cause of these deaths. We have lost 3patients due to postpartum haemorrhage and one due to eclampsia. The study also showed that maternal morbidity rate was high. Two of our patients had major complications, i.e. uterine rupture and vesicovaginal fistula. The conclusion is that forceps are not free of risk. They are valuable instruments in expert hands. The risks associated with forceps must be balanced against the potentially more serious sequelae associated with caesarean sections