title: Changing perspectives of infectious causes of maternal mortality.
abstract: OBJECTIVE
  Infections significantly contribute to maternal mortality. There is a perceived change in the spectrum of such infections. This study aims to estimate the contribution of various types of infections to maternal mortality.
  
  
  METHODS
  We retrospectively reviewed records of maternal death cases that took place between 2003 and 2012 in the Christian Medical College, Vellore, India. The International Classification of Diseases-Maternal Mortality was used to classify the causes of deaths and World Health Organization near-miss criteria were used to identify organ dysfunction that occurred before death. Infections during pregnancy were divided into three groups, i.e., pregnancy-related infections, pregnancy-unrelated infections, and nosocomial infections.
  
  
  RESULTS
  In this study, 32.53% of maternal deaths were because of some type of infection as the primary cause. The contribution of pregnancy-related infections was comparable with that of pregnancy-unrelated infections (16.03% vs. 16.50%). Metritis with pelvic cellulitis, septic abortions, tuberculosis, malaria, scrub typhus, and H1N1 influenza (influenza A virus subtype) were among the most commonly encountered causes of maternal death due to infections. Another 7.07% of cases developed severe systemic infection during the course of illness as nosocomial infection. A significant majority of mothers were below 30 years of age, were primiparae, had advanced gestational age, and had operative delivery. Cardiovascular and respiratory system dysfunctions were the most common organ dysfunctions encountered.
  
  
  CONCLUSIONS
  The contribution of pregnancy-unrelated infections to maternal deaths is significant. Control of these diverse community-acquired infections holds the key to a reduction in maternal mortality along with the promotion of clean birthing practices. Nosocomial infections should not be underestimated as a contributor to maternal mortality.
authors.affiliation: Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India ; Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Halder
authors.affiliation: Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India.
authors.forename: Reeta
authors.initials: R
authors.lastname: Vijayselvi
authors.affiliation: Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India.
authors.forename: Ruby
authors.initials: R
authors.lastname: Jose
keywords: Infections; maternal mortality; organ dysfunction