Indirect Obstetrics Causes of Maternal Death: A-20 Year Retrospective Autopsy Study at the Korle-Bu Teaching Hospital

Abstract

Background: The pattern and contributions of indirect causes of maternal deaths in Ghana from autopsy data have not been studied. The aim of this study was to estimate the proportions, the spectrum and demographic characteristics of maternal deaths that resulted from indirect obstetrics causes, and to offer recommendations.
Material and methods: This was a retrospective study of the above stated parameters from autopsy records in the department of pathology of Korle-Bu Teaching Hospital (KBTH).
Results: Approximately 15.2%, of all maternal deaths during the period of study were indirect obstetric causes with a mean age of 28.0 years. About 32.5% of the deaths were recorded in women within 25 – 29 year age group. A little more than a third (35.9%) of the deaths occurred in a health facility. The common underlying indirect causes of death were: infections 99 (39.4%), SCD 73 (29.1%), anaemia in pregnancy 32 (12.7%), chronic liver disease (CLD) 15 (6.0%), cardiovascular disorders (CVS) 10 (4.0%), pulmonary
thromboembolism (PE) 8 (3.2%) and neoplastic lesions 5 (2.0%). The common infections were: HIV/AIDS 24 (24.2%), pneumonia 19 (19.1%), purulent bacterial meningitis 17 (17.2%), malaria 9 (9.1%) and tuberculosis 8 (8.1%). The common complications of SCD leading to death were: anaemia 40 (54.8%), haemolytic crisis 10 (13.7%) and acute chest syndrome 9 (12.3%). The major complications of anaemia and CLD in pregnancy leading to death were congestive cardiac failure 28 (87.7%) and septicaemia 7 (46.7%). Deaths due to CLD 3 (37.5%) CVS 6(40.0%) and neoplastic lesions 3 (60.0%) were commoner within the age group of 30 – 34 years. Deaths due to CVS disorders 6 (60.0%) and neoplastic lesions 3 (60.0%) occurred commonly in health facilities.
Conclusion: The study found that 15.2% of all maternal deaths were due to indirect causes. These commonly occurred in the community and in the 25 -29 year age group. Infections were the commonest cause of death. The authors conclude that indirect causes of maternal deaths cannot be ignored and that efforts should be focused on their reduction. Research is needed in this
area of maternal death including the mechanisms by which these cause death and what programme could reduce it.