The research conducted aimed to investigate the characteristics of maternal mortality trends and associated causes. The findings from the study provide valuable insights into the demographics of the participants, trends in maternal deaths over five years, leading causes of maternal deaths, and factors influencing the outcome of birth.
The demographic data revealed that most maternal deaths occurred among women aged 25 to 29, which aligns with previous research highlighting this age group as being at higher risk(9). Additionally, most participants had a gravida and parity of 2, indicating that women with a previous pregnancy were more susceptible to maternal deaths. Studies have shown that a history of bleeding during a previous pregnancy increases the risk of intrapartum or postpartum haemorrhage, which can result in death if not promptly managed. Additional risk factors include a previous cesarean section, multiple pregnancies or polyhydramnios, placenta previa, and prolonged labour(10).
The distribution of delivery locations revealed that a significant number of births occurred in hospitals (45.2%) and health centers (43.8%), while home deliveries accounted for a smaller percentage (11.0%). Hospitals offer advanced medical technology and specialized care, making them a preferred choice for expectant mothers, suggesting that women in the study had access to institutional healthcare services. Health centers, on the other hand, provide primary healthcare services, including prenatal and delivery care, highlighting their importance in maternal healthcare. Home births involve deliveries at the woman's own residence, often with the assistance of midwives or trained healthcare professionals.
The trend analysis demonstrated fluctuations in maternal deaths over the five years. Notably, there was a significant increase in deaths in 2018, followed by decreases in 2019 and 2020, and a slight increase in 2021. The reasons for these fluctuations require further investigation, as they could be influenced by various factors such as changes in healthcare policies, access to prenatal care, or improvements in emergency obstetric care(9). Understanding the underlying causes of these trends is crucial for implementing effective interventions and allocating resources to reduce maternal mortality rates consistently.
Similar to the study conducted by Aden JA, Ahmeda HJ, and Östergrenb P (6) this study indicated that postpartum haemorrhage(35%) was the leading cause of direct maternal deaths, thus also aligns with other studies(11). This emphasizes the importance of effective management and timely access to appropriate healthcare interventions during and after childbirth. Active medication during the third stage of labour should be used regularly to lower the incidence of postpartum haemorrhage(12).
According to the findings, eclampsia was the second most common direct cause of maternal death (19%). Eclampsia is a serious complication of preeclampsia. (13) It's a rare but lethal illness in which elevated blood pressure leads to seizures during pregnancy(14). Eclampsia occurs when a pregnant woman with preeclampsia has new generalized tonic-clonic seizures. Eclamptic seizures can occur before delivery, 20 weeks after conception, during delivery, or after delivery(15).
Cerebrovascular accident (CVA), was also a significant contributor (16%) to maternal deaths. Pregnancy does increase the risk of stroke due to factors such as high blood pressure, gestational diabetes, and blood clots(16). The presence of CVA highlights the need for early detection, monitoring, and management of hypertensive disorders during pregnancy. The increased prevalence of stroke during pregnancy, particularly in the postpartum period, and its significant relationship with hypertension disorders of pregnancy (particularly preeclampsia), indicate that severe hypertensive patients should be followed up after birth(17). Successful stroke treatment, recovery, rehabilitation, and prevention rely heavily on advancements in pre-clinical and clinical care (18).
Among the different types of pregnancy-induced hypertension, the data demonstrates that HELLP syndrome is a prevalent(11%) cause of maternal mortality. The syndrome of hemolysis with a microangiopathic blood smear, elevated liver enzymes, and low platelet count, is more commonly known by the acronym HELLP syndrome in pregnant and postpartum patients(19). The presence of HELLP syndrome highlights the utmost importance of timely identification and proper management of this rare but life-threatening liver disorder in pregnant women. Sepsis is also shown to be among the common factors(8%). The findings also highlight the need for comprehensive strategies to address sepsis as a preventable cause of maternal deaths(20).
Furthermore, the data revealed that anaemia was one of the leading causes of death. Anaemia increases the risk of dying from a haemorrhage by reducing a woman's haematological reserve.(10)
According to the data analysis, the predominant pregnancy outcome observed was live birth, accounting for 69% (n = 50) of the total pregnancies. 22(31%) of the pregnancies resulted in bad outcomes, Stillbirth 10(14%), predelivery deaths 8(11%), Spontaneous abortion 2(3%), ECTOPİC1(1%) and induced abortion 1(1%). The observed outcomes may be attributed to complications arising from maternal deaths. Abosede OI and Omowaleola AM have substantiated this notion by highlighting the substantial influence of various direct and indirect causes of maternal deaths on neonatal outcomes (9, 21).
The analysis of factors associated with the outcome of birth among mothers who died revealed a statistically significant positive association between gestational age and the likelihood of a live birth. As gestational age increased, the odds of a live birth also significantly increased. This finding emphasizes the critical role of optimal prenatal care and timely delivery in improving birth outcomes for mothers at high risk of mortality. Interestingly, other factors such as age group, gravida, parity, time of death, mode of delivery, and place of delivery did not emerge as statistically significant predictors(22). This suggests that while these factors may still be important considerations in maternal care, they may not have a direct impact on the outcome of birth among mothers who die.
In conclusion, this research contributes valuable insights into maternal deaths and the factors associated with the outcome of birth among mothers who died. The findings underscore the importance of targeted interventions to address leading causes of maternal deaths, improve access to quality prenatal care, and ensure timely delivery. Further research is warranted to explore the underlying factors influencing the observed trends in maternal deaths and to validate the findings in larger, representative populations. The knowledge gained from this study can inform evidence-based strategies and policies aimed at reducing maternal mortality and improving birth outcomes.