Thesis on Maternal Deaths in Dhaka Medical College Hospital

Bangladesh is one of the developing countries where the maternal mortality is extraordinarily high. There has not been any substantial improvement in reduction of maternal mortality towards the ambitious goal of halving the rate which has been included in millennium Development Goals (MDGs). This retrospective study conducted in Dhaka Medical College Hospital has shown the maternal mortality ratio to be 22.21/1000 live births.
The deaths were common among 20-30 yrs of age, of para 1-2, coming from low socio-economic condition having no or irregular antenatal check up. Eclampsia has been found to be the commonest cause of death, next in order being obstetric haemorrhage & speticaemia was the final causes of death in patients who died from Unsafe abortion & Pulmonary oedema & CVA were the common final causes of death among eclampsia patients, haemorrhagic shock being the common final causes among obstetric haemorrhage & septicaemia was the final causes of death in patients who died from Unsafe abortion & obstructed labour. Injudicious use of oxytocin was the common cause of rupture of uterus which is still common in Dhaka Medical College Hospital. All these observations are reflecting the overall substandard level of care in this part of the country.

Pregnancy is a precious and happy event for a mother to be; yet in the developing countries many women die due to pregnancy related complications. In most Asian countries maternal death account for 20-45% of all deaths in women of reproductive age1. It is estimated that around 5,85,000 women die each year from pregnancy related complications2. Less than one percent of these deaths occur in developed countries, demonstrating that they could be avoided if resources and resources and services were available2. The MMR is highest in Africa, but the largest number of maternal deaths occur in South Asia due to high density of population3.
Maternal death may be due to direct or obstetric causes (70-80%) or indirect causes (20-25%). Besides these there are other contributory factors these are socio-economic, environmental and organizational. The most common causes are:

§ Hemorrhage
§ Sepsis
§ Unsafe abortion
§ Prolonged labour/obstructed labour, hypertensive disorder of pregnancy especially eclampsia.
A maternal death is defined as-the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of duration and the site of pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental cause 5.
- Direct obstetric deaths (70-80%) are those resulting from complications of pregnancy, delivery or their management. Such conditions are abortion, ectopic pregnancy, preeclampsia, eclampsia, antepartum haemorrhage, postpartum haemorrhage and puerperal sepsis.
- Indirect death (20-25%) include conditions present before or develop during pregnancy but aggravated by the physiological effects of pregnancy and strain of labour. These are anaemia. Cardiac disease, diabetes, thyroid disease, viral hepatitis etc.