Maternal mortality

Maternal mortality in Chittaranjan Seva Sadan, Calcutta, in 1983, 1985 and 1986 was 2.45, 3.01 and 2.8 per thousand respectively. Abortion contributed a little in 1983 and 1985, whereas it was 15.7% in 1986. Haemorrhage was the commonest single cause of death in 1983 (28%) and 1985 (21.4%) as opposed to eclampsia in 1986 (28.9%). Infective hepatitis during pregnancy and labour was the commonest indirect cause of maternal mortality followed by anaemia. Usual difficulties like lack of antenatal care, multiparity, low socio-economical status, illiteracy, etc, in populated developing countries are responsible for this sad state of affairs in this country as well.     

Maternal and perinatal mortality

A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved socioeconomic standards, better obstetric and pediatric services, education of the public to use such services, and treatment of diseases complicating pregnancy and research. The clinical and practical aspects of obstetric care are the most important areas in training undergraduates. For existing facilities to yield maximum benefits, hospital deliveries should be restricted to high risk patients. To accomplish this, closer integration of the hospital and domiciliary services is necessary.     

Maternal mortality in India

Authors worked on maternal mortality in India from 1992-94. This article is a review article on the basis of authors' experience. The article starts with the brilliant sentence, 'Maternal mortality in India is unacceptably high' and ends with the suggested strategies to solve the problem.