Analysis of Trends, Causes, and Risk Factors of Maternal Mortality in Sakon Nakhon Hospital: A 22-year retrospective study (fiscal years 2003 to 2024)

Abstract

Objectives: To analyze the trends, causes, and contributing risk factors of maternal mortality at Sakon Nakhon Hospital over a 22-year period.
Materials and Methods: A retrospective review was conducted utilizing hospital records of maternal deaths. Data sources included inpatient medical charts, antenatal care (ANC) records, and documentation from maternal mortality review conferences. The variables collected encompassed maternal demographic characteristics, gravidity, parity, number of ANC visits, gestational age at initiation of ANC and at the time of death, location of ANC services, pre-existing comorbidities, causes and timing of maternal death, and assessments based on the Three Delays Model. Additionally, to evaluate the impact of healthcare system changes, maternal mortality rates and associated characteristics were compared before and after the implementation of the 2020 health service reform.
Results: Between fiscal years 2003 and 2024, a total of 87,041 live births and 83 maternal deaths were recorded at Sakon Nakhon Hospital, yielding an overall maternal mortality rate (MMR) of 95.36 per 100,000 live births. A temporal trend analysis revealed a decline in MMR from 106.77 per 100,000 live births prior to 2016 to 56.17 during the period 2017–2019. However, the MMR subsequently increased to 82.02 in the period 2020–2024 after the health service reform. Among the maternal death cases, only 28% of women received at least four quality antenatal care (ANC) visits, while another 28% had no ANC visits at all. Common comorbidities identified included extremes of maternal age (adolescents and women of advanced maternal age) and diabetes mellitus. Notably, 12% of the cases had no documented comorbidities. A shift in the leading causes of maternal death was observed over time, with obstetric hemorrhage predominating prior to 2016, and non-obstetric medical complications emerging as the leading cause in subsequent years. The Three Delays Model Analysis showed that the majority 47% had delay in decision to seek care while another 38% had delay in reaching health care and 15% had delay in receiving quality care.
Conclusion: The MMR declined in the period 2017–2019 and subsequently increased in the period 2020–2024 after the health service reform. Enhancing early access to and the quality of antenatal care, conducting systematic evaluations for maternal comorbidities, and ensuring timely referral to appropriate levels of care are critical strategies for reducing maternal mortality. The observed changes in maternal death patterns following 2020 suggest that the decentralization policy implemented that year may have had implications for the effectiveness of the obstetric referral system. Further investigation is warranted to evaluate the policy’s impact on maternal health outcomes.