Changing Trends in Maternal Mortalities Rates— A Retrospective Study of 20 Years at a Tertiary Teaching Hospital of Uttar Pradesh
Authors: Gupta Nidhi 
Published: April 2010

ABSTRACT
Though India had set a goal of reducing MMR to 200/1,00,000 live births by the year 2000 AD; it is a figure difficult to achieve even in 2005.
Majority of maternal deaths in developing countries are due to preventable causes. These deaths can be avoided if there is proper utilization of essential obstetric care, early detection of complications and efficient emergency services. A retrospective review of maternal deaths will help us to find out the faults and lacunae at various levels and help us to plan out remedial strategies for all health care workers right from the primary health care to tertiary care at teaching hospitals. So, with this in mind a retrospective study of maternal deaths occurring in the Department of Obstetrics and Gynecology, SN Medical College, Agra over last 20 years was done. This data was further analyzed to study whether there were any changing trends in the causes of maternal death over the years.

Objective
To study the changing trends in maternal mortalities rates over 20 years at a tertiary teaching hospital of Uttar Pradesh.

Study Design
A retrospective Urban based teaching hospital study over 20 years in 2 phases.

Patients and methods
A retrospective review of 676 maternal deaths out of 25,614 live births was done in the Department of Obstetrics and Gynecology, SN Medical College, Agra over a period of 20 years in two phases.
• Phase — I (1986-1995)
• Phase — II (1996-2005).
A thorough analysis of individual records of all cases of maternal death was done. MMR for every year was calculated from the number of maternal deaths and number of live births per year. The causes of death were analyzed with special attention to determine the avoidable factors in each maternal death.

Results
There were 394 maternal deaths out of 13736 live births in phase I and 282 deaths out of 11,878 births in Phase II. The present study shows that hemorrhage was the most important cause of death in both the phase, 21.7% and 26.8% respectively. A decline in the percentage of death due to anemia has also been observed from 26.9% in phase I to 22.9% in phase II, but there has been no marked change in the percentage of deaths due to rupture uterus, ectopic pregnancy, ARF, heart disease, DIC and other causes. Two more important causes of death were added in phase II that is encephalitis and AIDS contributing to 0.6% of the total deaths. The clinical profile of the women in the two phases remained unaltered. Preventable factors responsible for maternal mortality have shown some decline in phase II, though preventable factors still account for 82.7% of the deaths.

Conclusion
This review shows that there has been some reduction in MMR in the last 20 years. But it is still a long way from what has been achieved in developed countries. Further reduction requires an improvement in the present health care system and their better utilization by the general population. We also have to improve the status of women through education and vocational training so that they can understand and make their voice heard in matters concerning their health.