Descriptive study of maternal deaths in castle street hospital for women; a changing trend

Abstract

INTRODUCTION: Deaths from pregnancy complications remain an important public health problem. With the development of the health care system in Sri Lanka maternal mortality rate has come down significantly. Castle Street Hospital for Women is one of the leading tertiary centers with ICU facilities providing maternal health care

in Sri Lanka. We have analyzed the maternal deaths occurred during the period of 1st of January 1998 to 31" of December 2004. Objectives: To describe socio-demographic characteristics, causes of maternal deaths, and the contributory factors associated with these deaths. Method: Retrospective study of maternal deaths during the period of 1"' January 1997 to 31" of December 2004 using patients case notes, ICU notes and autopsy findings when available. Results: There were 111,617 deliveries and 73 maternal deaths at CSHW during the period giving crude MMR of 65.per 100,000 births. Sixty six of these deaths were analyzed. Most of the deaths were in the age range of 25 to 29 years. Primipara accounted 33.3% of deaths and second pregnancies accounted for another 33.3% of deaths. Out of these deaths 55.1% had received shared care while 10.6% had never received any antenatal care. PIH was the commonest (18%) risk factor identified during the antenatal period while in 50% of cases there were no risk factors identified. PIH and its complications accounted for 28.8% of deaths while post partum hemorrhage (16.7%) and medical disorder (16.7%) were also important causes of maternal deaths. Out of the PIH related deaths 78.9% were among transferred patients. Hepato-reanl failure accounted for 36.8% of PIH related deaths. Most of deaths have occurred between the 2"d and 42" days of delivery. ICU care was to 83% of patients before death. In 85% of cases autopsy reports were not available. CONCLUSIONS: PIH and its complications is the most important cause of maternal mortality at CSHW. It is the commonest risk factor identified during antenatal period. PPH and medical disorders also remain important causes. ICU facilities were available for most of the patients.