Autopsy-certified maternal mortality at Ile-Ife, Nigeria

Abstract

Aim: Maternal mortality is a major health problem, especially in Nigeria, where accurate autopsy-based data on the prevalent causes are not readily available. The aim of this study was therefore to accurately determine the causes of maternal death as seen in a tertiary health facility in Nigeria.

Materials and methods: This was a descriptive, retrospective review of the postmortem autopsy findings from cases of maternal death at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 5-year period. Analyses were performed for differences in proportions using PEPI computer programs for epidemiologists (P is significant at <0.05).

Results: A total of 84 cases of maternal deaths were used for the study. Approximately 71.4% of the maternal deaths were due to direct causes and 28.6% were due to indirect causes. The mean age at the time of death was 27.9±7.5 years. Overall, the three leading causes of death were obstetric hemorrhage (30.9%), complications of abortion (23.8%), and nongenital (nonobstetric) infections (14.2%). Of the direct causes of maternal death, obstetric hemorrhage (43.3%) was the leading cause, with postpartum hemorrhage accounting for most (65.0%) of such deaths; other causes included complications of unsafe induced abortion (33.3%) and of labor (11.7%). Of the indirect causes, nongenital infections (50.0%), anemia (25.0%), and preexisting hypertension (20.8%) accounted for the majority of the maternal deaths. There was disparity between the clinical and autopsy diagnoses in 34 of the 84 cases (38.1%).

Conclusion: The leading causes of maternal death in this study are similar to those in other developing countries. Autopsy is an invaluable tool in accurately determining the cause of maternal death.

Keywords: Nigeria; autopsy; causes; maternal mortality.

Figure 1

Parity in relation to the direct causes of maternal death. Notes: Parity groups: 1, Nullipara (never given birth); 2, Para 1 (given birth one time); 3, Para 2–4 (given birth two, three, or four times); 4, >Para 4 (given birth more than four times). Obstetric hemorrhage and complications of labor were more common among Para 2–4 individuals, whereas the complications of abortion and preeclampsia/eclampsia were more common in the Nullipara group (P=0.009). Abbreviations: AC, complications of abortion; CL, complications of labor; PE, preeclampsia/eclampsia; OH, obstetric hemorrhage.