Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

  • Junu Shrestha Manipal College of Medical Sciences https://orcid.org/0000-0002-8683-2689
  • Sangeeta Gurung Manipal College of Medical Sciences
  • Ashika Shrestha Manipal College of Medical Sciences
  • Anjali Subedi Manipal College of Medical Sciences
Keywords: developing country, eclampsia, maternal death, maternal mortality, tertiary referral center

Abstract

Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it.

Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients.  Data analysis was done using SPSS version 16.

Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths.

Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.

Downloads

Download data is not yet available.

Author Biographies

Junu Shrestha, Manipal College of Medical Sciences

Assistant Professor, Department of Obstetrics and Gynecology

Sangeeta Gurung, Manipal College of Medical Sciences

Lecturer, Department of Obstetrics and Gynecology

Ashika Shrestha, Manipal College of Medical Sciences

Lecturer, Department of Obstetrics and Gynecology

Anjali Subedi, Manipal College of Medical Sciences

Lecturer, Department of Obstetrics and Gynecology

References

1. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387(10017):462-474. DOI: https://doi.org/10.1016/S0140-6736(15)00838-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26584737
2. Ministry of Health and Population (MOHP) [Nepal], New ERA, Macro International Inc. Nepal Demographic and Health Survey 2006. Kathmandu, Nepal: Ministry of Health and Population, New ERA, Macro International Inc; 2007.
3. Ministry of Health and Population (MOHP) [Nepal], New ERA, ICF International Inc. Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, ICF International Inc; 2012.
4. Ministry of Health [Nepal], New ERA, ICF International Inc. Nepal Demographic and Health Survey 2016: Key Indicators. Kathmandu, Nepal: Ministry of Health [Nepal], New ERA, ICF International Inc; 2017.
5. Dhakal S. Maternal mortality falls in Nepal but inequalities exist. Lancet. 2007; 370(9595):1301. DOI: https://doi.org/10.1016/S0140-6736(07)61560-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17939186
6. Suvedi BK, Pradhan A, Barnett S, Puri M, Chitrakar SR. Poudel P, et al. Nepal maternal mortality and morbidity study 2008/2009: Summary of preliminary findings. Kathmandu, Nepal: Family Health division, Department of Health Services, Ministry of Health, Government of Nepal; 2009.
7. Rana A, Pradhan N, Manandhar B, Bitsta KD, Adhikari S, Gurung G, et al. Maternal mortality over the last decade: a changing pattern of death due to alarming rise in hepatitis in the latter five-year period. J Obstet Gynaecol Res. 2009; 35(2):243-51. DOI: https://doi.org/10.1111/j.1447-0756.2008.00946.x PMID: https://www.ncbi.nlm.nih.gov/pubmed/19708172
8. Rijal P, Agrawal A, Pokharel H, Pradhan T, Regmi MC. Maternal Mortality: A review from Eastern Nepal. Nepal Journal of Obstetrics and Gynaecology. 2014; 9(1):33-36. DOI: https://doi.org/10.3126/njog.v9i1.11185
9. Ghimire S. Maternal Mortality: Sharing experience from Nobel Medical College Teaching Hospital. Nepal Journal of Obstetrics and Gynaecology. 2014; 7(2):33-35. DOI: https://doi.org/10.3126/njog.v7i2.11140
10. Upadhyaya I. Maternal death reviews at a tertiary care hospital. JNMA J Nepal Med Assoc. 2014; 52(193):713-718. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26905554
11. Begum S, Aziz-un-Nisa null, Begum I. Analysis of maternal mortality in a tertiary care hospital to determine causes and preventable factors. J Ayub Med Coll Abbottabad. 2003; 15(2):49-52. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14552250
12. Das R, Biswas S, Mukherjee A. Maternal Mortality at a Teaching Hospital of Rural India: A Retrospective Study. International Journal of Biomedical and Advance Research. 2014; 5(2):114-117. DOI: https://doi.org/10.7439/ijbar.v5i2.578
13. Bangal V, Giri P, Garg R. Maternal Mortality at a tertiary care teaching hospital of Rural India: A retrospective study. Int J Biol Med Res. 2011; 2(4):1043-1046
14. Murthy BK, Murthy MB, Prabhu PM. Maternal Mortality in a tertiary care hospital: A 10-year review. Int J Prev Med. 2013; 4(1):105-109. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23411635
15. Yadav K, Namdeo A, Bhargava M. A retrospective and prospective study of maternal mortality in a rural tertiary care hospital of Central India. Indian Journal of Community Health. 2013; 25(1):16-21.
16. Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005; 106(6):1228-1234. DOI: https://doi.org/10.1097/01.AOG.0000187894.71913.e8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319245
17. Simkhada B, van-Teijlingen ER, Porter M, Simkhada P. Major problems and key issues in Maternal Health in Nepal. Kathmandu Univ Med J (KUMJ). 2006; 4(2):258-263. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18603913
18. Gehendra M, Xiuhua G, Wang W. Strategy for improvement of maternal health in Nepal. International Journal of Science and Research. 2015; 4(2):694-698.
19. El-Gharib MN, Rakha AM, Awara AE, Mahfouz AE, Elhawary TS. Causes of maternal deaths in Tanta University Hospital. Clinical Medicine reviews in Women’s Health. 2010; 2:79-83. DOI: https://doi.org/10.4137/CMRWH.S5907.
Junu Shrestha Photo
Published
2017-12-20
How to Cite
1.
Shrestha J, Gurung S, Shrestha A, Subedi A. Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal. J Lumbini Med Coll [Internet]. 20Dec.2017 [cited 22May2022];5(2):58 -63. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/151
Section
Original Research Article