Retrospective Comparative Study of Obstetric complications and Maternal Mortality in Registered and Unregistered women at Tertiary Care Hospital.

Background: At tertiary care hospital, many women with obstetric complications are referred not only from private clinics/hospitals, but also from nearby primary health centers and urban health centers. There are women who come for delivery, who have not taken any ante natal care (ANC). Complication can arise at any time during pregnancy, childbirth and postnatal period and in absence of intervention, there is a high feto-maternal morbidity and mortality. With every maternal death there are many life threatening complications known as ‘maternal near miss’.Objectives: 1.To analyze causes of referrals of unregistered patients coming to our institute.2.To analyze pregnancy outcomes, Obstetric complications and maternal mortality in registered and unregistered women coming to our institute. 3.To analyze near miss cases and to analyze causes of maternal mortality and reasons of delay. Methods:This retrospective comparative study was conducted after due permission from the Scientific Advisory Committee and Institutional Ethics Committee of Sheth V S Medical Research Foundation Trust and data was collected as per pre-tested structured proforma from December 2009 to February 2010. Analysis of 1171 patients was done. Results: Out of total 1171 women included in the study, 952 (81.2 %) were registered and 219 (18.7%) were unregistered women. Proportion of unregistered women who had less than 3 ante natal visits 109 (49.7%) was significantly higher compared to registered women 95 (9.9%) (x2 = 195.97; P<0.0001). Severe anaemia was found to be significantly higher in unregistered women 18 (8.2%) as compared to registered women 1 (0.1%) (x2 = 68.442; P<0.0001). Transfusion of blood or other blood product was significantly higher in unregistered women 44 (20%) compared to registered women 31 (3.2%) (x2 = 84.177; P<0.0001) . Because of multi-disciplinary team approach at our institute, many women with complications in unregistered group could be saved (maternal near miss). No Maternal Mortality was reported in registered group. Maternal mortality in unregistered group was due to delay in deciding to seek care and due to delay in reaching appropriate care. Total of 1139 live births were reported during the study period, hence maternal mortality ratio (MMR) of study was 439. Conclusion: All women need access to antenatal care, institutional delivery and post partum care. Complication can arise at any time in absence of intervention; there is a high feto-maternal morbidity and mortality. Hence, delays in deciding to seek care and delay in reaching appropriate care must be