title: Maternal mortality over the last decade: a changing pattern of death due to alarming rise in hepatitis in the latter five-year period.
abstract: OBJECTIVE
  To study the causes of maternal mortality in two consecutive five year periods over a decade (1997-2001/2002-2006) in a university hospital.
  
  
  METHODS
  A maternal mortality over 10 years (1997-2006) was analyzed prospectively from the Obstetrics/Gynecology Department of Tribhuvan University Teaching Hospital.
  
  
  RESULTS
  The maternal mortality ratio of 267.5/100 000 live births was affected by 83 (41 [49.3%] direct, 36 [43.3%] indirect and six [7.2%] non-obstetric) maternal deaths in 31,021 live births. Direct cause was led by infections (n=23, 27.7%): 15 septic abortions (two [2.4%] spontaneous and 13 [15.6%] induced; seven of these occurred in 1997-2001); along with seven (8.6%) cases of puerperal sepsis; a case of antenatal septic shock; and a case of hemolysis, elevated liver enzyme levels, and low platelet count syndrome. There were eight (9.8%) cases of obstetric hemorrhage (six post-partum hemorrhage; two abortions); eclampsia (n=2); severe pregnancy-induced hypertension with hemolysis, elevated liver enzyme levels, and low platelet count syndrome (n=1); and cesarean complications included one from anesthesia and another surgical, which was included under post-partum hemorrhage. There were two cases of pulmonary embolism and four unexplainable deaths. Indirect causes included infective hepatitis (n=19, 22.8%) (13 of these occurred in the more recent 5-year period [2002-2006]), followed by heart disease (n=6), tuberculosis (n=5, 6%), anemia (n=3, 3.6%) and a case each of meningitis, chronic renal failure and diarrhea. Six non-obstetric deaths occurred: one from a road traffic accident; and five due to suicidal (n=1) and accidental (n=4) burns.
  
  
  CONCLUSIONS
  Maternal mortality over a period of a decade in an institutional setting exhibited induced septic abortion as the main cause of maternal death during the first five years of the study period (1997-2001). In the second five years of the study period (2002-2006) an alarming rise in infective hepatitis became the main cause of maternal death.
authors.affiliation: Department of Obstetrics/Gynecology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. prof.drranaa@hotmail.com
authors.forename: Ashma
authors.initials: A
authors.lastname: Rana
authors.forename: Neelam
authors.initials: N
authors.lastname: Pradhan
authors.forename: Bekha
authors.initials: B
authors.lastname: Manandhar
authors.forename: Kesang Diki
authors.initials: KD
authors.lastname: Bitsta
authors.forename: Silu
authors.initials: S
authors.lastname: Adhikari
authors.forename: Geeta
authors.initials: G
authors.lastname: Gurung
authors.forename: Archana
authors.initials: A
authors.lastname: Amatya
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D016751:Hepatitis E / Q000401:mortality*; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D013997:Time Factors