Maternal Mortality: Causes, trends and delays in care at Tertiary care hospital, Pakistan

Objective: To assess the maternal mortality ratio (MMR), causes, trends and delays in care over a period of twelve years at institutional level. Methods: This cross-sectional study was conducted over a 12 years period (2011-2022) at Services Hospital, Lahore, Pakistan. Maternal mortality ratio was calculated as number of maternal deaths per 100,000 live births. The study period was divided in two equal halves i.e. 2011-2016 and 2017-2022. Causes, trends in maternal mortality and delays were analyzed and compared between the two study periods. SPSS-23 was used for data analysis. Results: There were 222 maternal deaths and 47,853 live births during the study period. The cumulative MMR was 463.92/100,000 live births with a decreasing trend over 12 years. Postpartum hemorrhage and cardiac disease in pregnancy were leading cause of death in 44(31.65%) and 31(22.3%) of patients in 2011-2016, while hypertensive disorders in 18(21.69%) patients and sepsis in 15(18.0%) patients were significantly responsible for maternal mortality in 2017-2022 (p=0.00). Analysis of 12 years data showed first delay i.e. delay in seeking care was the commonest seen in 92(41.44%) patients, followed by second delay in 29(13.06%) and third delay in 27(12.16%) patients. Postpartum period and first delay were significantly associated with maternal mortality (p=0.05 and <0.001). Conclusion: Reduction in maternal mortality is a great challenge for developing countries like Pakistan. Although maternal mortality has declined over period of twelve years in our study, targeted interventions at community level are needed to address the delay in seeking care and improve maternal outcomes.