title: Facility-based review of 296 maternal deaths at a tertiary centre in India: could they be prevented?
abstract: OBJECTIVE
  The aim of this study was to identify causes of maternal mortality at the facility and to assess the standard of care, deficiencies in health services and preventability of these deaths using facility-based maternal death reviews.
  
  
  METHODS
  This was a prospective study at a tertiary care hospital that included all women who died during pregnancy or within 42 days of being pregnant during 2005-2010.
  
  
  RESULTS
  A review of 296 maternal deaths revealed that 59% of these occurred in medical wards. Indirect maternal deaths (54%) outnumbered the direct deaths (46%). Main causes were hepatitis (18%), hemorrhage (10%) and puerperal sepsis (10%). Only 5% of the women had received antenatal care at the facility. One-third (34%) were referred from other centers. The majority (74%) were critically sick at admission. Most of the women (62%) died postpartum. Substandard care and deficient health services were identified in 8% and 20% of the cases, respectively. Sixteen (5%) maternal deaths were deemed preventable and another 36 (12%) possibly preventable. Since most of the preventable deaths (12/16) were due to hemorrhage, measures to control postpartum hemorrhage were promoted at the facility. Findings of the maternal death reviews were regularly conveyed to the State Health Department for prioritization and resource allocation to prevent maternal mortality.
  
  
  CONCLUSIONS
  More maternal deaths occurred in the medical than in the obstetrics wards at the facility. The leading causes were hepatitis, hemorrhage and puerperal sepsis. Most of the deaths were non-preventable as the women were critically sick at admission; however, substandard care and health service deficiency were contributory in some of the cases.
authors.affiliation: Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Goswami
authors.forename: Asmita Muthal
authors.initials: AM
authors.lastname: Rathore
authors.forename: Swaraj
authors.initials: S
authors.lastname: Batra
authors.forename: Chandan
authors.initials: C
authors.lastname: Dubey
authors.forename: Shakun
authors.initials: S
authors.lastname: Tyagi
authors.forename: Leena
authors.initials: L
authors.lastname: Wadhwa
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006801:Humans; D007194:India; D063130:Maternal Death; D008428:Maternal Mortality; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: maternal death review; maternal mortality; preventable maternal deaths