Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study


  • Divya Khanna Department of Community Medicine, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
  • Jai Veer Singh Department of Community Medicine & Principal, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
  • Monika Agarwal Department of Community Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Vishwajeet Kumar Director of Community Empowerment Lab, Lucknow, Uttar Pradesh, India



Case-control study, Post-partum haemorrhage, Maternal death


Background: The WHO estimates that, of the 529 000 maternal deaths occurring every year 136 000 take place in India amongst which postpartum haemorrhage (PPH) being the most (29.6%) commonly reported complication. However deaths from PPH can be prevented. The purpose of this study was to identify the risk factors contributing to maternal deaths amongst women who develop PPH.

Methods: This was a community based paired case-control study done in rural areas of Lucknow, UP (India) done in a period of one year. Thirty-one maternal deaths due to PPH (cases) were matched and compared with two mothers who survived from PPH (controls). Data was analysed using SPSS version 17.0 and Open Epi version 2.3. The appropriate significance test was applied using MacNemar test for paired data. Risk factors obtained significant in bivariate analysis were subjected to conditional multiple logistic regressions for adjustment and controlling the effect of confounding variables. Results have been given in form of unadjusted Odds ratio (UOR) and adjusted Odds ratio (AOR).

Results: It was seen that the mothers who had taken ≥4 antenatal visits during the index pregnancy had a protective effect against deaths due to PPH. Home delivery raised the odds of death by seven times.

Conclusions: Deaths due to PPH can be reduced by ensuring institutional delivery, good antenatal care and better referral facilities, especially for mothers from weaker sections of society.


WHO and UNICEF. Countdown to 2015: Maternal, newborn & child survival. Building a Future for women and children: the 2012 report. Geneva: World Health Organization and UN Children’s Fund, 2012.

WHO, UNICEF, UN Population Fund and the World Bank. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. Geneva: World Health Organization, 2012.

Miller S, Lester F, Hensleigh P. Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low-Resource Settings. J Midwifery & Women’s Health. 2004;49(4):283–92.

Haeri S, Dildy III GA. Maternal Mortality From Hemorrhage. Seminars Perinatol. 2012;36(1):48–55.

Freedman LP, Waldman RJ, Pinho HD, Wirth ME, Chowdhury AM, Rosenfield A. UN Millennium Project 2005. Who's got the power? transforming health systems for women and children. Task force on child health and maternal health. UN Millennium Project 2005. Who's got the power? transforming health systems for women and children. Task force on child health and maternal health. 2005.

Registrar General of India. Maternal mortality in India: 1997-2003: trends, causes and risk factors: Table 6. New Delhi: Office of the Registrar General of India; 2006: 23.

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-74.

Ganatra BR, Coyaji KJ, Rao VN. Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India. Bull World Health Organization. 1998;76(6):591-8.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.

International classification of disease (ICD). World Health Organization; Available at: http://www.who. int/classifications/icd/en/index.htm. Accessed on 14 May 2012.

Lucknow district: Census 2011 data. Available at: Accessed on 24 September 2012.

Special Bulletin on Maternal Mortality in India 200-7-09. Sample Registration System. New Delhi: Office of Registrar General of India, 2011.

Lalonde A, Daviss B, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004–2006. Int J Gynecol Obstet. 2006;94:243-53.

Simkhada B, Porter MA, Teijlingen ER. The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study. BMC Pregnancy Childbirth. 2010;10(34):1-10.

Mesko N, Osrin D, Tamang S, Shrestha BP, Manandhar DS, Manandhar M. Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components. BMC International Health Human Rights. 2003;3(1):3.

Mumtaz Z, Salway SM. Gender, pregnancy and the uptake of antenatal care services in Pakistan. Sociol Health Illness. 2007;29(1):1-26.

Erci B: Barriers to utilization of prenatal care services in Turkey. J Nursing Scholarship. 2003;35(3):269-73.

Short S, Zhang F: Use of maternal health services in rural China. Popul Stud (Camb). 2004;58(1):3-19.

Gabrysch S, Campbell Oona MR. Still too far to walk: Literature review of the determinants of delivery service. BMC Pregnancy and Childbirth. 2009;9(34):1-18.

Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: Application of the 3 delays model. BMC Pregnancy Childbirth. 2017;17(1):219.

Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries. PLoS ONE. 2010;5(6):11190.

Puri A, Yadav I, Jain N. Maternal mortality in an urban tertiary care hospital of north India. J Obstet Gynecol India. 2011;61(3):280–5.

Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ. Postpartum hemorrhage in resource-poor settings. Int J Gynecol Obstet. 2006;92:202–11.

Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG Int J Obstet Gynaecol. 2008;115(10):1265–72.

Tort J, Rozenberg P, Traorѐ M, Fournier P, Dumont A, et al. Factors associated with postpartum hemorrhage maternal deaths in referral hospitals in Senegal and Mali: A cross sectional epidemiological survey. BMC Pregnancy Childbirth. 2015;15(235):1-9.




How to Cite

Khanna, D., Singh, J. V., Agarwal, M., & Kumar, V. (2018). Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study. International Journal Of Community Medicine And Public Health, 5(7), 2814–2820.



Original Research Articles