RESUMO
Background: The World Health Organisation (WHO) in 2012 introduced the 10th revision of International Classification of Disease (ICD 10) to deaths in pregnancy, labour and puerperium (ICD-MM) for consistent collection, analysis and interpretation of information on maternal deaths. The proper use of this classification requires training to avoid heterogeneity and error in the classification of maternal deaths.Methods: We analysed the Maternal Death Review (MDR) forms of 295 deaths over a period of 5 years (January 2014 to December 2018 inclusive) occurring at a tertiary health centre in Western India. The ICD-MM classification was used to reassign the cause of death.Results: There were 295 deaths in women during pregnancy, childbirth and puerperium during the 5 year period. Of these there were 294 maternal deaths and one coincidental death. There were 173 deaths of the direct type (58.84%), 105 deaths of the indirect type (35.71%) and 16 deaths (5.44%) of the unspecified type. Obstetric haemorrhage was the highest contributor to direct deaths (23.8%) and anaemia contributed to the maximum deaths from indirect causes (13.6%) followed by liver diseases in pregnancy (10.54%).Unanticipated complications of management accounted for 2% of the total deaths. There was considerable inaccuracy in assigning cause of death by consultants who were untrained in the use of the ICD-MM classification.Conclusions: ICD-MM classification promotes an accurate assignment of the cause of death. Training of healthcare providers performing maternal death reviews in the use of this classification is essential to identify accurate underlying cause of death and contributory conditions.
RESUMO
Objective: To evaluate various causes of maternal death and MMR at our institute and analysis of delays that contribute to maternal death. Methodology: This observational cross sectional study was conducted from January 2010 to December 2015 in Surat Municipal Institute of Medical Education and Research (SMIMER). All the maternal deaths of the institute during the study period were included in the study. A pre-structured coded Performa provided by National Rural Health Mission was used for present study. The factors associated with maternal deaths were classified by using the ‘three delays’ framework. Results: The overall MMR of the study was 244 per 100,000 live births. Direct obstetric causes were responsible in 68.04% cases of maternal death. Obstetric haemorrhage like antepartum haemorrhage (APH) and postpartum haemorrhage (PPH) were responsible in 24.74% of cases. Other important direct causes were septicaemia and eclampsia (10.30% and 9.27% cases respectively). Indirect causes were responsible in 31.95% cases of maternal death. Only 20.61% women had taken three or more ANC visits. 35.05% women had not taken any ANC care. 1st delay was found in 57.73% cases and 2nd delay in 34.02% cases. Conclusion: Maternal death review systems help to evaluate the trends of maternal deaths and help to develop subsequent policies and protocols to tackle life threatening obstetric emergencies.