Determinants of Mortality in Primigravida in Peoples Medical College Nawabshah.

Abstract

Objective:  To determine the determinants of maternal mortality in primigravida.

Methodology: This cross-sectional, descriptive study was conducted from June 2023 to Dec 2023 at the department of Gynecology and Obstetrics of Peoples University of Medical & Health Sciences for women, Nawabshah; a tertiary care center. We studied overall causes of death (direct and indirect) during pregnancy, delivery, and puerperium. Those patients who died after admission were included and analyzed on specially designed proforma. Information collected from hospital records/patient attendants. The reason for admission, status at arrival, cause of death, and potential variables answerable for death were recognized. Data including age, booking status, parity, gestational age, and relevant variables from the current pregnancy, along with the traveling distance from the clinic, was recorded on Performa, and analyses were done on SPSS adaptation 25.

Results: During study period 43 maternal deaths occurred in their first pregnancy. The live birth rate was 10020. MMR counted to 429 per lac live birth. Most frequent death occurs at 19 years of age, from the rural population (62%), the majority un-booked (72%), history of domestic violence (48%) was not uncommon. Among these primigravida; 60% having no formal education, 65% were referral cases presented with obstetrical complication and in labor (34.9%). Almost all deaths were due to direct causes (99%). The highest contribution was by hemorrhage 39.5% (PPH=27.9%+ APH 11.6%), followed by sepsis (27.9%), pre-eclampsia/ eclampsia (18.6%), pulmonary embolism (7%), while 4.7% deaths due to unsafe abortion in early pregnancy complications. We found only 2.3% of deaths due to indirect causes. 

CONCLUSION: It is crucial to highlight that tackling maternal mortality requires a comprehensive strategy, which encompasses enhancing healthcare infrastructure, guaranteeing access to high-quality prenatal and obstetric care, advocating for education and awareness, and tackling social determinants of health. Recognizing and dealing with these factors can help decrease maternal mortality rates for all expectant mothers, including primigravidae.

Key words: Primigravida, Maternal Mortality Rate, antenatal care, Obstetric emergency.