Prevalence and pattern of perinatal maternal deaths in a tertiary hospital in Enugu, Southeast Nigeria

Background: Maternal mortality ratio (MMR)- the number of maternal deaths per 100,000 live births has continued to be on the increase in Sub-Saharan Africa despite efforts at improved obstetric care. Maternal mortality ratio as high as 1895 per 100,000 live births has been reported in Nigeria. Obstetric haemorrhages and hypertensive disorders of pregnancy have continued to lead the primary causes of maternal deaths in several studies.
Objective: The objective of this study is to assess the prevalence, causes, and pattern of perinatal maternal deaths in the Obstetrics and Gynaecology Department of Enugu State University Teaching Hospital, Parklane, Enugu. 
Methodology: This is a 10-year retrospective study covering January 2014-December 2023. Data related patients’ age, parity, booking status and diagnosis/cause of death were collected using a structured proforma from the prenatal, labour, and the postnatal ward records as well as the records from the theatre. Data was analyzed using SPSS version 25.0 and the results presented in tables and charts as frequencies, and means with standard deviations.
Results: A total of 16,137 live births occurred during the study period while 69 maternal deaths were recorded. Majority of the women that died were between 25-39years. Most of them 63 (91.3%) were married, 30.4% were para 1 while 58 (84.1%) presented as unbooked emergencies. The prevalence of perinatal maternal deaths from 2014 – 2023 is less than 1%. The trends in perinatal deaths over the 10-year period showed that most deaths (10 deaths for each year) occurred in the first 3 years of this study (2014-2016) and was followed by a gradual but unsteady reduction in the number of deaths in the subsequent years. The commonest causes of perinatal maternal deaths were Obstetric haemorrhage (mostly postpartum haemorrhage PPH) (43.5%) followed by Hypertensive disorders -Eclampsia/Severe Preeclampsia (39.1%) and Septicaemia/puerperal sepsis (17.4%) in that order. There was no significant association between demographic characteristics of the subjects and causes of perinatal maternal death (p > 0.05).
Conclusion: The death of a woman during childbirth has remained a public health challenge especially in the low resource settings like ours. Obstetric haemorrhages and hypertensive disorders of pregnancy have remained the leading causes of this catastrophe. Strategies to promote awareness, improve women education and empowerment, enhance the availability, accessibility, equipment of available health facilities as well as training, retraining and motivation of available health personnel will go a long way in cubbing this menace.