Safe motherhood--a long way to achieve.

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.

Evaluation of women seeking sterilisation reversal.

A total of 1120 women attending at Regional Centre of Excellence (RCOE), RG Kar Medical College and Hospital, Calcutta from October, 1989 to July, 1998 with the request for sterilisation reversal (SR) were evaluated step by step for fitness of SR operation on the basis of history, clinical examination, pre-operative investigations, fertility status and laparoscopic findings. One thousand and sixty couples completed their evaluation. Majority of the SR seekers were young (< 30 years) and significant number (8.9%) of women came in late age (> 40 years). Most (85.8%) of the women had one or no child. The main reason for requesting reversal was death of children (91.8%). Only 43.3% were ultimately found fit for SR operation and rest (56.7%) were refused. Presence of 2 or more children in not remarried couple (13.8%), gross pelvic pathology (2.35%), advanced age (8.7%), seminopathy (4.05%), and some medical diseases (3.2%) were important reasons before pre-operative investigations for refusal. Faulty sterilisation technique (11%) was responsible for refusal at laparoscopic evaluation. The need of critical evaluation of all women seeking reversal has been emphasised in this study. Various aspects related with demand for SR and preventive measures to improve the success of this procedure have been critically discussed.