Maternal mortality over the last decade: A changing pattern of death due to alarming rise in hepatitis in the latter five-year period

Aims: To study the causes of maternal mortality in two consecutive five year periods over a decade (1997–2001/2002–2006) in a university hospital. Method: A maternal mortality over 10 years (1997–2006) was analyzed prospectively from the Obstetrics/Gynecology Department of Tribhuvan University Teaching Hospital. Results: The maternal mortality ratio of 267.5/100 000 live births was affected by 83 (41 [49.3%] direct, 36 [43.3%] indirect and six [7.2%] non‐obstetric) maternal deaths in 31 021 live births. Direct cause was led by infections (n = 23, 27.7%): 15 septic abortions (two [2.4%] spontaneous and 13 [15.6%] induced; seven of these occurred in 1997–2001); along with seven (8.6%) cases of puerperal sepsis; a case of antenatal septic shock; and a case of hemolysis, elevated liver enzyme levels, and low platelet count syndrome. There were eight (9.8%) cases of obstetric hemorrhage (six post‐partum hemorrhage; two abortions); eclampsia (n = 2); severe pregnancy‐induced hypertension with hemolysis, elevated liver enzyme levels, and low platelet count syndrome (n = 1); and cesarean complications included one from anesthesia and another surgical, which was included under post‐partum hemorrhage. There were two cases of pulmonary embolism and four unexplainable deaths. Indirect causes included infective hepatitis (n = 19, 22.8%) (13 of these occurred in the more recent 5‐year period [2002–2006]), followed by heart disease (n = 6), tuberculosis (n = 5, 6%), anemia (n = 3, 3.6%) and a case each of meningitis, chronic renal failure and diarrhea. Six non‐obstetric deaths occurred: one from a road traffic accident; and five due to suicidal (n = 1) and accidental (n = 4) burns. Conclusion: Maternal mortality over a period of a decade in an institutional setting exhibited induced septic abortion as the main cause of maternal death during the first five years of the study period (1997–2001). In the second five years of the study period (2002–2006) an alarming rise in infective hepatitis became the main cause of maternal death.