SEVERE ACUTE MATERNAL MORBIDITY;

A REVIEW IN A TERTIARY CARE HOSPITAL

Abstract

Objective: To determine the frequency and pattern of severe obstetric morbidity and mortality. Design: Cross sectional study.
Period: 1st Oct 2005 to 30th Sep 2007. Setting: Military Hospital Rawalpindi. Methods: Cases of severe acute maternal morbidity and maternal
mortality were collected and comparisons made of disease profile, organ system dysfunction, parity, mode of delivery, whether incident
occurred at home or in the hospital and also whether patient was booked or unbooked. Results: One hundred and ten cases of Severe Acute
Maternal Mortality (SAMM) and eleven cases of maternal mortality were identified. More maternal deaths occurred in patients who had not
booked themselves for antenatal care. The four most frequent cases of severe morbidity were: hypertension 36 (32%), haemorrhage 32 (29%),
anemia 16 (14%), sepsis12 (10%) in this order. The four causes of deaths were: sepsis 4 (36%), hypertension 4(36%), amniotic fluid embolism
2(18.% ), haemorrhage 01(10%). There were statistically significant number of patients in mortality arm of sepsis group (p=0.01) In patients with
SAMM there was a higher percentage of patients undergoing caesarean sections in haemorrhage and hypertension arm compared to
background rate of 35%. Multi organ failure, cerebral and respiratory system involvement was linked to both SAMM and morbidity. Maternal
mortality index was highest for sepsis (25%), and lowest for haemorrhage (3%) with hypertension intermediate in position (10%). Conclusions:
A review of Severe Acute Maternal Morbidity offers a non threatening stimulus for improving quality of care. Comparison of Severe acute
maternal morbidity with maternal death gives a different disease pattern and shows that different factors operate in each condition. Therefore
both reviews complement each other.