Registry-Based Study of Maternal Mortality in Al-Rusafa-Baghdad

Abstract

Background: All pregnant women are at risk and can develop complications at any time during pregnancy, delivery and after delivery. However, women and families can learn how to avoid unplanned pregnancies, and if pregnant, they can learn the importance of receiving antenatal care, how to identify danger signs, plan for emergency referrals, and choose safe birthing options. When problems arise, and referral is timely, complications can be treated in health facilities that are adequately equipped with supplies, medications and fully staffed with competently trained health workers.

Objective: identifying the maternal mortality ratio (MMR) of maternal death in Baghdad Al-Rusafa Health Directorate (maternity hospitals) for the period (2009- 2011), determining, and analysis of the causes of the death according to the most important variables.

Subject, materials and methods: A descriptive study in which review of all maternal death records for the period (2009-2011); the study was conducted in (Baghdad Al-Rusafa Health Directorate, Medical Legal Institute). The data was collected during the period (1st of January to 30th of April 2012) by an informative form sheet which includes age, occupation, history of ANC, obstetrical history, history of previous abortion, type of labor, place of starting and finishing labor, place of death, cause of death, year of registration. Pilot study was done through reviewing ten forms from the study sample for about two hours per day, one time a week. There were obstacles that the following information is not found which represent the exclusion criteria, unknown place of ANC, frequency of ANC visit, investigations done during pregnancy, detailed medical history, referral history, date of lastabortion, date of last delivery, diseases diagnosed during pregnancy. Results: The study includes 43 recorded cases of maternal death which had been reviewed, the registered MMRs were lowest during the year 2009 (21.41) and highest during the year 2010 (27.57). The current study revealed that the age ranged between (17-44 years) with a mean of 30.627 ±6.49 years (standard deviation). Maternal deaths were lowest among the age group below 20 (6.9%) and highest among the age group 30-39 (44.18%). Most of dead mothers were died during 3rd trimester of their pregnancies 35 (81.39%), were grand multiparas 21 (48.83%), with no ANC 30 (69.76%), with high rate of midwife attendance 25 (58.13%), were high after vaginal deliveries 28 (65.11%) rather than Caesarean Section deliveries, and in the majority labor started and finished at house 17 (39.53%). The main cause was PPH 26 (60.46%) which was high in all years of study high in all maternal ages and stages of parity and gestational ages, PPH was followed by pulmonary embolism 4 (9.3%), followed by equal distribution for APH (ante partum hemorrhage) and eclampsia 3 (6.97%), followed by equal distribution for (acute endometritis and peritonitis) and obstructed labor 1 (2.32%), and 5 (11.62%) for indirect causes.

Conclusions: the MMR was lowest during 2009 and highest during 2010, PPH was the leading cause followed by pulmonary embolism, risk of death was high among age group (30-39) years, grand multiparas, in third trimester, and high among pregnant women who are not}, risk of death increase with midwife attendance and with poor ANC attendance.