An Investigation Into Maternal Mortality

BY ABHISHEK JAGUESSAR

Taj Mahal
Taj Mahal-One of the seven wonders of the world, One of the Greatest monuments, dedicated to the memory of the Queen Mumtaz , by her husband Emperor Sahajahan, is a testimony and a grim reminder of the tragedy of maternal mortality, that can befall any women in childbirth.
14th Dec.2001 Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

Introduction
Maternal mortality is a very sensitive index of M.C.H. Care available in a community. So this study was undertaken at M.K.C.G.Medical College Hospital, BERHAMPUR, ORISSA, INDIA, to analyse all aspects of maternal deaths to find out the responsible factors at different levels of the health care delivery system and to suggest remedial measures.
14th Dec.2001 Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

THE MAGNITUDE OF THE TRAGEDY

Period of study: - 01-01-96 to 31-07-2000

Total births Normal deliveries Complicated / abnormal del. Total live births Total maternal deaths Maternal Mortality Rate (16.45 / 1000 )
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7244 2467 4777

6685 110 1645

Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

PATIENT PROFILE
TABLE I: - AGE OF THE VICTIMS AGE NUM % 20 & < 28 25.45 21-25 34 30.91 26-30 32 29.09 31-35 12 10.91 36-40 2 01.82 41+ 2 01.82 TOTAL 110 100

TABLE II: - PARITY PARITY NUM %

14th Dec.2001

PRIMI 32 29.09

1 33 30

2 16 14.55

3 16 14.55

4+ 13 11.81

TOTAL 110 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

PATIENT PROFILE
TABLE III: - EDUCATIONAL LEVEL LEVEL NUM % ILLIT 52 47.27 PRIM 45 40.91 SECON 10 09.09 COLLEGE 03 2.73 TOTAL 110 100

TABLE IV: - ECONOMIC STATUS STATUS NUM %

14th Dec.2001

POOR 37 33.64

LOWER MIDDLE 66 60

UPPER MIDDLE 7 6.36

HIGHER NIL 0.0

TOTAL 110 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

PATIENT PROFILE
TABLE V: - ANTENATAL CARE TYPE NUM % NIL 86 78.18 HW 12 10.91 FRU 6 5.45 SEC 2 1.82 PVT 3 2.73 TERT 1 0.91 TOTAL 110 100

TABLE VI: - MEDICAL TREATMENT FOR THE COMPLICATION PRIOR TO ADMISSION PLACE NUM %
14th Dec.2001

NIL 63 57.27

FRU 31 28.18

SEC 11 10

PVT 02 1.82

IN HOUSE 3 2.73

TOTAL 110 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH
TABLE VII: -TYPE OF MATERNAL MORTALITY TYPE OF DEATH DIRECT INDIRECT TOTAL
14th Dec.2001

NUMBER 83 27 110

% 75.46 24.54 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH ANALYSIS OF DEATH

TYPE OF CAUSES OF MATERNAL MORTALITY
INDIRECT 25%

DIRECT 75%

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH
TABLE VIII: - DIRECT CAUSES OF DEATH CAUSE OF DEATH 1 HAEMORRHAGE 2 PIH 3 UNSAFE ABORTION 4 RUPTURE UTERUS 5 OBSTRUCTED LABOUR 6 PUERPERAL SEPSIS 7 LSCS(ANAESTHESIA) 8 DIC (IUD) 9 ECTOPIC PREGNANCY 10 POSTPARTUM SHOCK TOTAL
14th Dec.2001

NUMBER 31 23 12 07 03 03 01 01 01 01 83

PERCENTAGE 28.18 20.91 10.91 06.36 02.73 02.73 00.91 00.91 00.91 00.91 75.46
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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH
DIRECT CAUSES OF MATERNAL DEATH 35 31 30 23 25 20 12 15 7 10 3 3 4 5 0
HAEMORRHAGE PIH UNSAFE ABORTION RUPTURE UTERUS OBSTRUCTED LABOUR PUERPERAL SEPSIS OTHERS

NUMBER

CAUSE
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ANALYSIS OF DEATH
TABLE IX: - INDIRECT CAUSES OF DEATH CAUSE OF DEATH 1) VIRAL HEPATITIS 2) ANAEMIA 3) MALARIA 4) HEART DISEASE TOTAL
14th Dec.2001

NUMBER 17 05 04 01 27

PERCENTAGE 15.45 04.54 03.64 00.91 24.54

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH
INDIRECT CAUSES OF MATERNAL DEATH
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NUMBER

4 1

VIRAL HEPATITIS ANAEMIA MALARIA HEART DISEASE

CAUSES
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ANALYSIS OF DEATH
TABLE X: - TIME PERIOD FROM ADMISION TO DEATH PERIOD NUM % <1 HR 13 11.82 <6HRS 20 18.18 <12HRS 26 23.63 <24HRS 26 23.63 <48HRS 12 10.91 >48HRS 13 11.82 TOTAL 110 100

TABLE X I: - LEVEL OF DELAY PRIOR TO ADMISSION LEVEL NUM % PATIENT 58 52.73 TBA 10 9.09 FRU 19 17.27 SEC 07 6.36 PVT 01 0.91 NO DELAY 15 13.63 TOTAL 110 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

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ANALYSIS OF DEATH
TABLE XII: - PREVENTABILITY OF MATERNAL DEATHS PREVENTABILITY YES NO TOTAL
14th Dec.2001

NUMBER 87 23 110

% 79.09 20.91 100

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

ANALYSIS OF DEATH ANALYSIS OF DEATH

PREVENTABILITY OF MATERNAL DEATHS
NO 21%

YES 79%
14th Dec.2001 Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

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ANALYSIS OF DEATH
TABLE XII: - FACTORS CONTRIBUTING TO DEATH FACTOR NO FACTOR 1 2 3 4 5 6 7 8 9 PATIENTS FAMILY LACK OF TRANSPORT POVERTY ENVIRONMENT & PUBLIC HEALTH HEALTH WORKER DEFICIENT HEALTH CARE - FRU DEFICIENT HEALTH CARE - SECONDARY DEFICIENT HEALTH CARE PRIVATE DEFICIENT HEALTH CARE - TERTIARY NUMBER OF INSTANCES 10 92 26 37 21 98 50 11 2 42 33 422
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10 LACK OF BLOOD TRANSFUSION TOTAL INSTANCES FOR 100 DEATHS

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

CONCLUSION
THESE TRAGIC CASE HISTORIES BEAR TESTIMONY TO THE FACT THAT THE DEATH OF A WOMAN IN PREGNANCY OR CHILDBIRTH IS RARELY THE RESULT OF CLINICAL COMPLICATIONS ALONE. ONCE COMPLICATIONS ARISE, SWIFT ACCESS TO HIGH QUALITY PROFESSIONAL TREATMENT IS ESSENTIAL, IF LIVES ARE TO BE SAVED.
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CONCLUSION
HOWEVER MORE IMPORTANTLY IT IS ESSENTIAL THAT ALL EFFORTS SHOULD BE MADE TO PREVENT THE OCCURRENCE OF THE COMPLICATIONS IN THE FIRST PLACE.

FOR THIS WE HAVE TO IMPROVE THE SOCIOECONOMIC ENVIORNMENT OF THE WOMEN, AS THE FACTORS CONTRIBUTING TO MATERNAL DEATHS ARE MULTIFACETED AND DIFFICULT TO TACKLE AT ONE STROKE.
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CONCLUSION
TO DECREASE THESE UNFORTUNATE & MOSTLY PREVENTABLE MATERNAL DEATHS, RESTRUCTURING OF M.C.H. SERVICES SHOULD BE DONE WITH PARTICULAR ATTENSION TO:
INCREASING COMMUNITY AWARENESS PROMOTION OF APPROPRIATE TECHNOLOGY AND

EFFECTIVE HEALTH CARE PLANNING STARTING FROM GRASSROOT LEVELS TO TERTIARY LEVELS

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CONCLUSION
MATERNAL MORTALITY IS A NEGLECTED TRAGEDY AND IT HAS BEEN NEGLECTED BECAUSE THOSE WHO SUFFER ARE NEGLECTED PEOPLE WITH LEAST POWER AND INFLUENCE THEY ARE POOR, THE RURAL PEASANTS AND ABOVE ALL WOMEN Maheler, 1987
14th Dec.2001 Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

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India's first child in the new year 2001

A boy, was born in Bangalore at 00.01 am on January 1. In the picture, along with the baby, is his mother, Sumitra (26). (AFP)

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

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MOTHERHOOD IS THE CHERISHED

DREAM OF A WOMAN.

LET US THINK FOR A MOMMENT.

WHY SHOULD SHE DIE FOR IT?

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Maternal Mortality- Dr.S.N.Panda, Dr.B.B.Dash & Dr.A.Patnaik

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DEDICATED TO THE UNFORTUNATE WOMEN DYING IN CHILDBIRTH