Maternal Mortality in a Tertiary Care Centre in Nepal

Introduction: Nepal has one of the highest maternal mortality rates. Aims and objective: To identify the maternal deaths and identify the causes and key risk factors. Method: A retrospective (descriptive) study was carried out at BPKIHS by analyzing the case sheets of all maternal deaths of four years (April 1998- March 2002). The cause of death and the factors that may have indirectly contributed to death were noted. Results: The total number of deaths during these four years was forty-four, with 61.4% of patients being multigravid and 96.5% unbooked. More than 85% of patients reported from periphery. The majority (93.18%) of deaths were due to direct causes. The most common cause of maternal death was sepsis (43.18%) of which septic abortion was the leading cause (27.27%). Hypertensive disorders accounted for 29.54% of deaths and out of these, eclampsia was the leading disorder. Haemorrhage accounted for 13.66% of deaths. There were two cases of rupture uterus (4.5%) Anaemia was found in 29.54% of cases and it may have contributed indirectly to maternal mortality. Three deaths (6.8%) were due to medical causes. Conclusion: Preventable causes accounted for majority of deaths. Septic induced abortion and eclampsia together accounted for more than 50 % of deaths. The non-availability of safe abortion services, the mountainous terrain, lack of good primary /district level hospitals and poor transport facility seem to be the most important reasons for most maternal deaths in our study. Key Words: Maternal Mortality, Nepal. [Trop J Obstet Gynaecol, 2004; 21:168-171