Maternal death analysis of Karnataka

For the FY:2015-16

Karnatak State Health System Resource Center

(KSHSRC)

Maternal death analysis • Data source: The analysis done based on maternal death line list collected

from districts through e-mail.

• A format for data collection was sent to district officials (RCHO).

• The designed formats were categorized as follows

– Name of the district

– Name of the deceased mother with husband

– Delivery date and time

– Date of Death & Time

– Age

– Number of living children (Gender wise)

– Delivery details (Hospital Name, Delivery conducted by whom)

– Place of death (Home, Hospital, on the way)

– Cause of death (Medical, Non medical)

– Out come of this pregnancy

– Hb % status

– Mother card number.

– ANC services provided (ANC1, ANC2, ANC 3, ANC4, IFA Tablet given)

• Consultants of KSHSRC were made responsible for collecting/validating and consolidation of data received from the districts.

• Facility wise maternal deaths were analysed.

• Total number of maternal deaths reported during the year 2015-16 : 635

• The maximum number of deaths reported at Belgaum district (81) and minimum deaths reported from Udupi district (2)

81% of Maternal deaths are of age between 20 to 29 years old

Age wise Maternal Deaths reported during the year 2015-16

16 - 19 34 5%

20 - 24 290 46%

25 - 29 224 35%

30 - 34 54 9%

35 - 39 33 5%

>= 40 0

0% 16 - 19

20 - 24

25 - 29

30 - 34

35 - 39

>= 40

Out of 635 cases, 150 are death due to PPH

Out of 631 cases, 111 are death due to CCF and other Cardiovascular causes /CVT Out of 631 Cases, 101 are due to Pre Eclampsia/PET Out of 631 Cases, 78 are due to Sepsis

Age wise and Cause wise Maternal death reported during the year 2015-16

2 8 7 3 6 5

13 7

55 58

19

47 42

6

34

9

12

4

38

63

9

33

24

4

29

2

3

5

14

3

10

4

1

11

5

8

5

2

4

30

16

111

150

34

101

78

13

83

19

0

20

40

60

80

100

120

140

160

0

20

40

60

80

100

120

140

160

Amniotic fluid embolism

APH CCF and other cardiovascular

causes/CVT

PPH Pulmonary emobolism

Pre Eclampsia/PET

Sepsis Severe Anaemia

Others Details not available

40 & above

35 to 39

30 to 34

25 to 29

20 to 24

16 to 19

TOTAL

Cause wise Maternal Deaths

150

111

101

92

78

34 30

23 16 13

0

20

40

60

80

100

120

140

160

PPH CCF and other cardiovascular

causes/CVT

Pre Eclampsia/PET

Others Sepsis Pulmonary emobolism

Amniotic fluid embolism

Details not available

APH Severe Anaemia

445 70%

37 6%

22 3%

13 2% 118

19%

Personnel handled delivery

Doctor

ANM/Nurse/SN/LHV

TBA

Other

Details Not available

Most number of deliveries are conducted by Doctors and specialists

Place of Delivery / Place of Death 356

125

10 5

107

32

299

124

72

138

0 2 0

50

100

150

200

250

300

350

400

Public Private Home In transit ANC Details Not available

Place of delivery

Place of death

5 Cases have delivered and died during transit on the way. 62 Cases have delivered at Govt. Hospitals and died when they were being shifted to higher facilities. 4 cases delivered at Home and died when they were being shifted to hospitals. 23 cases delivered at PVT Hospitals and died when they were shifted to higher care. 34 ANC cased died when they are being shifted to higher care.

Hb Status of reported Maternal deaths during the FY:2015-16

28 5%

469 80%

91 15%

Severe(Hb < 7)

Moderate (Hb 7 to 11)

Normal

85% Maternal death, have suffered from Anaemia. 80 % are Moderately anaemic, who may have turned to servere anaemic by the time of delivery which leads to various complications and cause for death. 5 % had suffered from severe anaemia

Cause of Maternal deaths and Hb status during the FY: 2015-16

- 469 Pregnant who are moderately anaemic, & 28 severely anaemic (497) -127 are dead due to PPH (25%) - 91% of PPH deaths are anaemic cases. - 104 are due to CCF & other Cardiovascular causes/CVT - 89% CCF/CVT deaths are anaemic cases - 92 are due to Pre Eclampsia/PET

- 87 % of pre Eclampsia/PET deaths are anaemic cases. -56 are due to Sepsis

4 6 6 4 2 4 1 1

18 13

87

110

29

76

56

5

67

8

6

11

11

29

12

12

1

9

0

0

20

40

60

80

100

120

140

Amniotic fluid embolism

APH CCF and other cardiovascular

causes/CVT

PPH Pulmonary emobolism

Pre Eclampsia/PET

Sepsis Severe Anaemia

Others Details not available

Normal

Moderate (Hb 7 to 11)

Severe(Hb < 7)

I Gravida 248 39%

II Gravida 153 24%

III Gravida 86

14%

IV Gravida 39 6%

V Gravida 18 3%

VI Gravida 5

1%

VII Gravida 3

0% NA 80

13%

Maternal deaths and Gravida during the FY:2015-16

492 469

450

340

474

0

100

200

300

400

500

600

ANC1 ANC2 ANC3 ANC4 IFA tablet

ANC Services given prior to the delivery of maternal death reported during the FY:2015-16 (Opportunities

System had to save these mothers )

Out of 528 deaths during/after delivery, only 474 (90 %)had received IFA tablets. 36 cases have not received IFA tablet among those who diagnosed as anaemic ANCs -479 No data available for the rest of the cases i.e 49

Total death during delivery / After delivery : 528

Time of death after delivery (excluding ANC deaths)

24

7 19

148

62

37

83

113

22

7

0

20

40

60

80

100

120

140

160

<= 3

0 m

inu

tes

30

min

to

1 h

r

1 H

r to

2 h

r

2 h

rs t

o 1

2 h

rs

12

to

24

hrs

24

to

48

hrs

2 t

o 8

day

s

8 d

ays

to 1

mo

nth

1 m

on

th t

o 4

2 d

ays

>42

day

s

Total no. of deaths reported within 24 hrs after delivery- 260

District wise causes of Maternal deaths during the year 2015-16

Sl.No District

Cause

Amniotic fluid

embolism

APH

CCF and other

cardiovascular causes/

CVT

PPH Pre

Eclampsia/PET

Pulmonary

emobolism

Sepsis Severe anemia

Others Details

NA Grand Total

1 Belagum 6 17 15 8 4 16 1 14 81

2 Bellary 3 2 4 13 12 2 5 1 4 46

3 Dharwad 12 4 9 5 11 2 1 44

4 Gulbarga 3 10 9 9 2 4 1 1 39

5 Bijapur 3 2 3 8 5 4 7 4 36

6 Mysore 2 1 4 8 8 5 3 31

7 Raichur 2 11 5 7 1 4 30

8 Chikballapur 1 1 4 5 4 3 1 4 3 26

9 Shimoga 4 3 11 3 1 2 2 26

10 Chitradurga 7 9 4 1 2 1 1 25

11 Bangalore Urban 4 2 2 7 3 5 23

12 Dakshina Kannada 1 1 8 2 5 5 22

13 Yadgir 1 1 6 6 3 5 22

14 Tumkur 2 8 9 1 1 21

15 Bidar 6 1 2 1 10 20

District wise causes of Maternal deaths contd....................

Sl.No District

Cause

Amniotic fluid

embolism

APH

CCF and other

cardiovascular causes/

CVT

PPH Pre

Eclampsia/PET

Pulmonary

emobolism

Sepsis Severe anemia

Others Details

NA Grand Total

16 Haveri 6 3 3 1 1 4 18

17 Koppal 1 3 6 4 1 1 1 17

18 Bagalkot 1 1 3 2 9 16

19 Davanagere 5 5 3 1 1 15

20 Kolar 4 6 3 2 15

21 Gadag 4 2 1 3 10

22 Hassan 3 3 4 10

23 Chamarajnagar 7 7

24 Kodagu 7 7

25 Uttara Kannada 2 1 1 2 1 7

26 Mandya 2 2 2 6

27 Ramanagar 1 1 1 1 1 5

28 Bangalore Rural 1 2 1 4

29 Chikmagalore 1 1 1 1 4

30 Udupi 2 2

Grand Total 29 16 109 150 100 34 78 13 83 19 635

PRIMARY CARE (SCs, PHCs)

SECONDARY CARE (CHCs, TLH)

TERTIARY CARE (DHs, Medical Collage Hospitals,

Super speciality Hospitals)

Sub Center

Sub Center

Sub Center

PHC CHCs/TLHs

DHs

Private Hospitals

Medical Collage hospitals and Super speciality hospitals

448 Cases registered at SC/PHC level

(GOVT Facility)

47 cases died during transit after delivery

18 cases died during transit after delivery

• 69 ANC cases died before delivery (26 died during transit)

• 10 cases delivered at home & died

• 95 cases delivered at private hospitals & died

• 247 cases delivered at Govt. hospitals & died

• 5 cases delivered on Ambulance & died

PRIMARY CARE (SCs, PHCs)

SECONDARY CARE (CHCs, TLH)

TERTIARY CARE (DHs, Medical Collage Hospitals,

Super speciality Hospitals)

Sub Center

Sub Center

Sub Center

PHC CHCs/TLHs

DHs

Private Hospitals

Medical Collage hospitals and Super speciality hospitals

187 cases delivered at Secondary care (Out of this 6 cases were

out of area cases (Reported in Shimoga district)

110 cases 15 cases died during transit after delivery

6 cases died during transit after delivery

• 36 ANC cases died before delivery (7 died during transit)

• 31 cases delivered at private hospitals & died

• 110 cases delivered at Govt. hospitals & died

THANK YOU