Maternal Mortality Patterns and Determinants in a Tertiary Care Centre in South India: A Retrospective Study

Abstract

Background: Maternal mortality remains a major public health challenge in developing countries despite significant improvements in maternal healthcare. Institutional reviews of maternal deaths provide valuable insight into demographic characteristics, referral patterns, and healthcare system gaps contributing to maternal mortality.[1,2]

Objective: To analyze the maternal mortality ratio (MMR), sociodemographic characteristics, and referral patterns among maternal deaths in a tertiary care centre in South India.

Methods: A retrospective hospital-based study was conducted in a tertiary care centre from January 2018 to December 2022. Data were obtained from case records, labour room registers, and hospital medical records. Maternal deaths were identified according to WHO criteria. Sociodemographic characteristics, referral patterns, and maternal mortality ratios were analyzed using descriptive statistics.

Results: A total of 66 maternal deaths were recorded during the study period. The maternal mortality ratio varied across the years, with values of 114.3 per 100,000 live births in 2018, 108.2 in 2019, 239.6 in 2020, 202.9 in 2021, and 123.0 in 2022. The highest maternal mortality ratio was observed in 2020, coinciding with the COVID-19 pandemic. The majority of maternal deaths occurred among women aged 26–30 years, representing the peak reproductive age group. Most women were housewives, indicating that maternal deaths were more common among economically dependent women. A large proportion of cases (87.9%) were referred from other healthcare facilities, predominantly government hospitals, highlighting the role of tertiary care centres in managing complicated obstetric cases. Late referrals accounted for nearly two-thirds of cases, indicating delays in recognition and referral of obstetric complications. Regarding mode of termination of pregnancy, emergency caesarean section was the most common mode of delivery, followed by vaginal delivery, while a small proportion of cases remained undelivered at the time of death. Analysis of the admission-to-death interval showed that the majority of deaths (84.8%) occurred more than 24 hours after admission, suggesting that many patients arrived in a critical condition requiring prolonged management.

Conclusion: Maternal mortality in this tertiary care centre was strongly influenced by referral delays and systemic healthcare factors. Strengthening referral systems and improving early detection of obstetric complications are essential to reduce maternal mortality.