Facility Based Maternal Death Review at Tertiary Care Teaching Hospital - An Observational Study

High Maternal mortality continues to be a challenge in reaching MDG 5 target. India still has not shown satisfactory progress in its MDG 5 achievements. Maternal death audit is a way to understand the hurdles and bottlenecks in reaching the target. The main objective is 1.To analyze the number and causes of maternal deaths at Pravara Rural hospital during study period 2.To find out the avoidable factors in causation of maternal deaths 3. To ascertain the role of various contributory factors in maternal deaths 4.To suggests remedial measures to improve the maternal health and reduce maternal deaths. A Retrospective and Prospective observational study was carried out at Pravara Rural hospital over a period of two years. Systematic Analysis of all maternal deaths during four and half year period (2011-2015) was done using Maternal Death Review system in relation to causes, contributory factors, and associated socio epidemiological factors. The results were analyzed by using qualitative and quantitative methods of analysis. In results there were 56 maternal deaths during study period with maternal mortality ratio of 208 per one lakh live births .Two third of the deaths were due to direct causes and remaining due to indirect causes. Postpartum hemorrhage and hypertensive diseases were the two common direct causes, where as acute respiratory distress syndrome, hepatitis were the common indirect causes of maternal deaths. All maternal deaths took place among the women of rural area. Sixty six percent out of maternal deaths were seen in unbooked cases. Most of the deaths (57.90%) occurred in illiterate women. Maximum number of maternal deaths (67.8%) were noted in women from lower socio economic class. Majority of the patients (78.57%) died in postpartum period. Sixty six percent of the deaths were due to direct cause and 33.92% deaths due to indirect cause. In conclusion, the Obstetric haemorrhage, hypertension, Liver and kidney diseases were mainly responsible for maternal mortality. It can be reduced by optimum antenatal and intranatal care. Facility based maternal death review can pinpoint the bottlenecks in implementation of maternal health programme implemented by government through National Rural Health Mission (NRHM).