Maternal Mortality and Referral Status in Chonburi Hospital: 16 Years (1996-2011) Experience

Abstract

Objective:

To assess maternal death, cause of death as well as maternal mortality ratio in Chonburi Hospital in total cases as well as in two subgroups whether cases were referred or not.

Material and Methods:

All maternal deaths in Chonburi Hospital from January 1996 to December 2011 were included. Data from department pool and hospital medical record was review.

Results:

Our total maternal mortality ratio (tMMR, total=referred cases and Chonburi Hospital own cases) and Chonburi Hospital maternal mortality ratio (CHMMR, Chonburi Hospital own cases) was 52.4 and 13.4 per 100,000 live births during 16-year period from 1996-2011. The tMMR rate seemed unchanged from tMMR during 1982-1991 we reported previously. However the figure for all 47 deaths was a bit exaggerated because there were added referred maternal deaths without added corresponding live births. Most or 74% were referred cases. Most deaths or 63.8% were direct maternal deaths. Top five causes of deaths were postpartum hemorrhage (PPH), amniotic fluid embolism (AFE), heart diseases, pregnancy induced hypertension (PIH) and abortion/ectopic pregnancy-related respectively. For Chonburi Hospital cases, top causes of death were AFE, heart diseases and PIH. Few arrived at first hospital (Chonburi Hospital or referring hospitals) in seriously ill condition: 8.3% and 37.1% for Chonburi cases and referred cases respectively. Most of referred cases, 74.3%, arrived at Chonburi Hospital in seriously ill condition. Eight cases (22.9%) arrived hopelessly (post cardiac arrest or cardiac arrest on admission, brain death or moribund condition). Many deaths were obviously or possibly preventable especially in category of PPH and abortion/ectopic pregnancy-related deaths.

Conclusion:

Our own CHMMR was 13.4 and comparable with that of developed country. Our tMMR, though a bit exaggerated, was at developing country MMR level. There is opportunity for improvement as many deaths seemed preventable. This needs improvement of all three pillar of safe motherhood: comprehensive reproductive health care, presence of skilled health professionals at delivery or procedure and emergency obstetric care.