Maternal Mortality: A 5-year analysis at a District Headquarter Hospital in Pakistan.

BACKGROUND: Maternal mortality ratio is an important figure reflecting the strength of a healthcare system. Traditionally the causes of maternal death are described by the three-delay model. This study was conducted to evaluate the causes and determinants of maternal mortality at a secondary level hospital in a rural area of northern Pakistan over a period of 5 years (2013-17). METHODS: This cross-sectional study was conducted in 2018 on hospital data for the previous 5 years (2013-17) regarding mortality in the Gynaecology department of District Headquarter hospital, Timergara. Cases of maternal death were identified and secondary data was retrieved from the hospital records and patient case sheets. RESULTS: Forty-seven cases of maternal death were identified over a period of 5 years and the average maternal mortality ratio calculated to be 110/100,000 live births. Haemorrhage was the commonest cause (36%) followed by uterine rupture (34%) and hypertensive disorders (21%). Most of the cases seen were in uneducated women belonging to the poor socioeconomic stratum (85%) aged 20 to 35 years (55%). 51% of the women were multigravidae coming from within a distance of 25-50 km from the hospital (53%) Majority of the dying mothers (57%) had no antenatal care and were seen arriving at the hospital in the evening shifts (48%). CONCLUSION: Causes and determinants of maternal death are complex and inter sectorial. Poverty, lack of education, antenatal care, family spacing and prompt access to emergency care contribute to maternal death.

A cross-sectional study of indications for cesarean deliveries in Médecins Sans Frontières facilities across 17 countries.

OBJECTIVE: To review the major indications for cesareans performed by Médecins Sans Frontières (MSF) personnel from the Operational Center Brussels. METHODS: A retrospective study was undertaken of all singleton cesarean deliveries from 2008-2012 for which indications were recorded. Location of project, age of patient, type of anesthesia, and duration of operation were also recorded. RESULTS: A total of 14 151 singleton cesarean deliveries were identified from 17 countries. Among the 15 905 indications recorded, the most common was failure to progress or cephalopelvic disproportion (4822 [30.3%]), followed by previous uterine scar (2504 [15.7%]), non-reassuring fetal status (2306 [14.5%]), and fetal malpresentation (1746 [11.0%]). Other indications were placenta or vasa previa (794 [5.0%]), uterine rupture (676 [4.3%]), hypertensive disorders (659 [4.1%]), placental abruption (520 [3.3%]), pre-rupture (450 [2.8%]), and cord prolapse (365 [2.3%]). CONCLUSION: Indications for cesareans in MSF settings differ from those in higher-income countries. Further investigation is needed for adequate emergency obstetric care coverage.