A study of post-surgical maternal mortality at tertiary care centre

Objective: To evaluate the post-surgical maternal deaths and to make recommendation & design a protocol for decreasing future mortality. Design Retrospective analysis of post-surgical maternal mortality. Methods Analysis of all post-surgical maternal deaths between January 2006 and December 2010. Results and Discussion: During the study period there were 95413 deliveries in the institute. The total number of maternal deaths from January 2006 to December 2010 were 285. Out of this, 88(30.88%) were post-surgical deaths. Amongst the victims majority were unbooked (75%), multiparous (43.18%), Hindu (79.55%), coming from rural (68.18%) area. (67.05%) belongs to age group between 21 to 30 years. (72.73%) were serious at the time of admission and (42.04%) patients had haemoglobin level below 7 gm%. More than half (60.22%) died within 24 hours of hospital admission. (48.86%) patients were taken for surgery within 4 hrs. (21.59%) deaths occurred within 4hrs after surgery, (38.64%) deaths within 4-12 hrs, (21.59%). Cesarean was done in (56.83%) cases. In (28.41%) cases hysterectomy was done for postpartum hemorrhage. Out of this (10.23%) were normal vaginal delivered, (9.09%) were rupture uterus, (5.68%) were cesarean hysterectomy, (1.14%) after forcep delivery and (2.27%) after evacuation & curettage. The most common indication for caesarean was antepartum eclampsia (20%) followed by obstructed labour (12.73%). Direct causes were responsible for 84.09% and indirect causes for 15.91% deaths. Majority (38.64%) were attributable to hemorrhage, hypertensive disorders (20.45%), pregnancy related sepsis (11.36%), pulmonary embolism (9.09%) and (2.27%) were anesthesia related. Other causes were anemia, jaundice, acute respiratory distress syndrome, heart disease, chronic hypertension, aspiration pneumonitis and HELLP syndrome.(25%) patients were given whole blood and in (38.64%) patient’s blood with platelets and fresh frozen plasma given. All the patients were associated with risk factors and lack of proper antenatal care, lack of knowledge, illiteracy, poor transport and late referral further increases the surgical risk. Conclusions: Good antenatal care, high risk screening, comprehensive emergency obstetric services, hospital delivery and incorporation of obstetric drills decreases the post-surgical deaths.