Major risk factors leading to maternal mortality in a tertiary care hospital

Background: Maternal mortality is a major public health issue in developing countries due to its shocking magnitude and lower declining pattern. In developing countries where 99% of maternal death is occurring, little or no progress has been made. Objective of this study was to identify the underlying causes and factors associated with maternal mortality, and recommendations for quality improvement in maternal and obstetric care. Methods: It was a retrospective individual case review of maternal mortality audit. All cases of maternal death from January 2015 to December 2017 at Sheikh Khalifa Bin Zayed Al Nayhan/Combined Military Hospital Muzaffarabad were reviewed. Results: In the study period 31 maternal deaths were identified in 20,018 live births. Causes were classified as Direct (80.64%), Indirect (6.45%), and Unspecified (12.9%). Major underlying causes were eclampsia (9 cases, 29.03%), obstetric and non-obstetric sepsis (5 cases, 16.13%), antepartum haemorrhage (3 cases, 9.68%), postpartum haemorrhage (3 cases, 9.68%), hepatic encephalopathy (3 cases, 9.68%), and one case each of rupture uterus, abdominal pregnancy, cerebral haemorrhage, bronchial asthma. Four cases were unspecified. Conclusion: Some of the preventable, direct and indirect causes of maternal death have been identified. Recommendations of audit approach helped the hospital team to identify direct and indirect causes of maternal mortality and helped the management to take steps to reduce preventable factors for maternal death. Pak J Physiol 2020;16(4):6‒9