title: Trends in maternal mortality and assessment of substandard care in a tertiary care hospital.
abstract: OBJECTIVE
  To assess the trends in maternal mortality and factors affecting substandard care at a tertiary care hospital in a developing country.
  
  
  METHODS
  All maternal deaths during a period of 11 years in a tertiary care hospital were studied. Maternal deaths were defined according to ICD-10. The principal cause and category of death, chief contributory factor, nature of care (standard or substandard), relationship to outcome and responsibility for substandard care (if any) were determined.
  
  
  RESULTS
  Among the 133 maternal deaths, 92 (69%) were due to direct causes, 38 (29%) were indirect and 3 (2%) were accidental deaths. Genital tract sepsis (26%), hypertension in pregnancy (24%) and obstetric hemorrhage (20%) accounted for over 70% of deaths. In 79% of deaths, the care was substandard and in 73% of deaths substandard care was felt to have influenced the adverse outcome. Overall maternal mortality rate was 98.5 per 100,000 deliveries. An increasing but insignificant (P=0.08) trend in maternal mortality was noted after 1991.
  
  
  CONCLUSIONS
  The majority of maternal deaths remain due to preventable and treatable obstetric complications. Maternal death enquiries of this nature facilitate identification of factors contributing to substandard care. It is important to ascertain that life threatening obstetric complications receive high quality emergency obstetric care at all levels.
authors.affiliation: Castle Street Hospital (Teaching) for Women, Colombo 8, Sri Lanka. ogy158@abdn.ac.uk
authors.forename: Prabhath T
authors.initials: PT
authors.lastname: Wagaarachchi
authors.forename: Lakshman
authors.initials: L
authors.lastname: Fernando
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D005831:Genital Diseases, Female / Q000401:mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007239:Infections / Q000401:mortality; D008428:Maternal Mortality / Q000639:trends*; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality; D011644:Puerperal Disorders / Q000401:mortality; D011787:Quality of Health Care; D013188:Sri Lanka / Q000453:epidemiology