Maternal mortality is an index of reproductive health of the society. High incidence of maternal deaths reflects poor quality of maternal services, late referral and low socioeconomic status of the community. The mean Maternal mortality rate in the study period was 302.23/100000 births. The current maternal mortality ratio (MMR) in India is 212/100,000 live births.[1
] Various studies done in India in the last 15 years have shown wide variation in MMR ranging from 47/100000 to 625/100000 births.[4
] Madhu Jain has reported a very high MMR of 2270/100000.[5
] This study has comparatively high MMR, which could be due to the fact, that our hospital is a tertiary care hospital and receives a lot of complicated referrals from rural areas of southern Maharashtra and also from North Karnataka at a very late stage.
In our study, 70% of maternal deaths were in the age group of 20 to 29 years, as highest numbers of births are reported in this age group. Similarly, 56.66% of maternal deaths were reported in multiparous patients. More maternal deaths were reported in women from rural areas (69.16%), unbooked patients (83.33%), illiterate women (65%), and women belonging to low socioeconomic status. (83.33%) All our findings were similar to studies by Jain,[5
In our study, 72.5% of maternal deaths were due to direct causes. Hemorrhage (26.66%), eclampsia (26.66%), and sepsis (18.33%) were the major direct causes of maternal deaths. Our findings were consistent with studies by Jain,[5
] and Shah.[9
Even today large number of maternal deaths is due to the classical triad of hemorrhage, sepsis, and eclampsia. All these are preventable causes of maternal mortality provided the treatment is instituted in time. Unfortunately, in many cases, patients were referred very late, in critical condition, unaccompanied by health care worker. Many patients had to travel a distance of 70 to 80 kilometers in a private vehicle to reach our tertiary center. Most of these deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers. Training of medical officers and staff nurses working in rural areas by programs like basic emergency obstetrics care (BEMOC) and skilled attendant at birth (SAB) training gives a ray of hope of reducing maternal mortality.
Indirect causes accounted for 27.5% of maternal deaths in our study. Anemia, jaundice, and heart disease were responsible for 10%, 9.16%, and 3.33% of maternal deaths, respectively. These findings were consistent with studies by Jain,[5
] and Onakewhor.[8
Maternal deaths can be prevented by improving the health care facilities in rural areas by ensuring round the clock availability of certain basic drugs like injection magnesium sulfate, tablet misoprostol as most maternal deaths in rural areas are still due to eclampsia and post partum hemorrhage. Early detection of high risk pregnancies and referring them to a tertiary center at the earliest can reduce the complications of high risk pregnancies. National Rural Health Mission (NRHM) can play a major role in reducing maternal mortality by advocating institutional deliveries and timely referral of high risk cases. Although we have not actually evaluated the impact of aforementioned educational programs on maternal mortality, it would be interesting to direct future studies in this regard.