Maternal Mortality in the Remote Islands of India—Unraveling the Conundrum

Abstract

Introduction: Reduction in maternal mortality has been a top priority in low- and lower middle-income countries of Asia-Pacific region. India, being one of them, has a major responsibility of reducing maternal mortality especially in light of the commitment on the part of the Sustainable Development Goals. Despite massive efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high especially in remote areas. This study aims at collecting the MMR data and analyzing in the context of island infrastructure. Material and Methods: This was a hospital-based cross-sectional study. The records of maternal deaths from January 2010 to December 2019 were collected from the medical record section and analyzed. Results: The MMR was estimated to be 95.63 per 100,000 live births. Majority of the patients were multigravida (82%) in the age group of 21 to 30 years (75%). Around 64% of them were referred cases. Majority (86%) of the deaths occurred in the postpartum period. Hemorrhage was the leading direct cause of maternal deaths (35.7%) followed by hypertensive disorders of pregnancy (HDP) (21.4%). Conclusion: Most maternal deaths are preventable. Early detection of high-risk pregnancies and early referral of such patients to a well-equipped center is the key to curb the catastrophe of mortality. Adopting methods like qSOFA (quick sequential organ failure assessment) for identifying patients requiring intensive care and miniPIERS (Preeclampsia Integrated Estimate of RiSk) model for predicting adverse outcome in HDP is the need of hour. More efforts should be made to retain the specialists in the islands.

Keywords

• eclampsia
• intensive care unit
• maternal mortality
• piers
• qsofa: quick sequential (sepsis-related) organ failure assessment
• three delays