Pathology of maternal deaths in Rivers state (a ten year autopsy review) in a referral hospital.

BACKGROUND: Most of the maternal death studies in this environment based their statistics on clinical cause with no reference to autopsy records. This gap of knowledge would be filled with autopsies performed on the victims.
OBJECTIVES: To highlight the importance of autopsy in the study of maternal mortality. DESIGN/
SETTING: A ten year (1st January 1991 - 31st December 2000) retrospective autopsy study of maternal deaths in University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt.
METHODOLOGY: The coroner's autopsy report and hospital autopsy records on maternal deaths were retrieved and re-evaluated for this study. Variables considered were the ages of the victims, primary place of antenatal care/management and the cause of death at autopsy.
RESULTS: A total of 60 maternal autopsies were performed during the period under review. Forty eight (80%) cases were direct maternal deaths of which haemorrhagic shock from ruptured ectopic pregnancy was the most common 21(35%). The highest frequency of direct maternal death occurred in the age group 20 - 29 years. Indirect (fortuitous) maternal deaths accounted for 20% cases of which cardiovascular disorders was the most common cause of death 4(7.1%) and the age group 40-49 years were most affected 4(6.7%). Majority of the deaths occurred at the traditional birth attendants (TBA) centres 26(43.3%) of which 25(41.7%) were direct or obstetric maternal deaths. The indirect maternal death was highest in the general hospitals 4(6.7%).
CONCLUSION: Maternal mortality is a common obstetric problem in this environment. As the death toll was highest in the TBA centers, they should be trained and be integrated to the health care delivery system. There should be an established referral system and improved emergency obstetric services including blood transfusion in our local health centres. These will drastically reduce the mortality rate.