Trends and causes of maternal mortality in Eastern province of Turkey

We aimed to analyse causes of maternal mortality cases in Eastern province of Turkey. Maternal mortality cases were retrospectively investigated. The cases were evaluated for age, gravida, age at first birth, gestational week, postpartum death time, educational status, illnesses in their history, high risk pregnan cies, pregnancy termination type, delivery methods and death causes. The distribution of these cases by type of death and years is examined. In addition, the causes of death were compared among groups according to their death pattern and years. A total of 69 maternal deaths were detected between January 2010 and December 2016. The maternal mortality rate was 20.1 per, 100000 livebirths. The mean age of the cases was 30.4 ± 7.6 and they had their first births when they were 20.9 ± 5.1 years old. Mean number of gravida was 3.9 ± 2.8. These cases were 32.3 ± 7.4 in the week of gestation when mortality occurred. The mean number of pregnancy follow-ups was 4.24 ± 4.0, postpartum direct maternal mortality time was 13.7 ± 25.5 days. The number of maternal mortality according to the years was respectively; 6, 12, 15, 16, 7, 13. When the causes of maternal mortality are examined; 26.1% of the cases had preeclamptic diseases, 15.9% had hemorrhage, 10.1% committed suicide, 8.7% had pulmonary embolism, 7.2% had cerebrova scular disease, 5.8% had heart disease, 5.8% had amnion fluid embolism, 4.3% had sepsis, 4.3% had traffic accidents, 4.3% had firearm injuries, 2.9% had malignancy, 1.4% had pneumonia, 1.4% had multiple organ failure, and 1.4% had died due to electric sho ck. Among the direct causes of death; preeclamptic diseases, hemorrhage and pulmonary embolism were the most common and among the causes of indirect death; cerebrovascular diseases, heart diseases and sepsis were the most common. Maternal mortality is an important obstetric complication that needs to be paid attention to. Preeclamptic diseases and hemorrhage continue to be the most common cause of maternal mortality.


1. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD -10), WHO Version for 2016.

2. Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (Eds.). On behalf of MBRRACEUK. Saving lives, improving mothers' care - Surveillance of maternal deaths in the UK 2011-2013 and lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2009-2013. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2015.

3. tality/maternal_mortality_text/en/

4. Alkema L, Chou D, Hogan D, 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: 462-474.

5. United Nations. The Millennium Development Goals Report 2015. New York: United Nations; 2015.

6. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: 323-333.

7. Turkyilmaz AS, Koc I, Schumacher R, Campbell OM. The Turkey national maternal mortality study. The European Journal of Contraception & Reproductive Health Care 2009; 14: 75-82.

8. World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICDMM. Geneva: World Health Organization, 2012.


10. Idoko P, Anyanwu MO, Bass S. A retrospective analysis of trends in maternal mortality in a Gambian tertiary health centre. BMC Res Notes 2017; 10: 493.

11. Obiechina Nj, Okolie V, Okechukwu Z, et al. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003-2012). Int J Womens Health 2013; 5: 431-436.

12. Tessema GA, Laurence CO, Melaku YA, et al. Trends and causes of maternal mortality in Ethiopia during 1990-2013: findings from the Global Burden of Diseases study 2013. BMC Public Health 2017; 17: 160.

13. Qin M, Zhu R, Du L, Lu J, Xu HQ, Zhu LP. Analysis of maternal deaths in Shanghai from 1996 to 2015. Zhonghua Fu Chan Ke Za Zhi 2017; 52: 386-391.

14. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130: 366-373.

15. Vangen S, Bødker B, Ellingsen L, et al. Maternal deaths in the Nordic countries. Acta Obstet Gynecol Scand 2017; 96(9): 1112-1119.

16. Centers for Disease Control and Prevention. Pregnancyrelated mortality surveillance. Available at: http://www.cdc. gov/reproductivehealth/MaternalInfantHealth PMSS.html. Retrieved December 21, 2016.

17. Engin-Üstün Y, Çelen Ş, Özcan A, et al. Maternal mortality from cardiac disease in Turkey: a population-based study. J Matern Fetal Neonatal Med 2012; 25: 2451-2453.

18. Nair M, Nelson-Piercy C, Knight M. Indirect maternal deaths: UK and global perspectives. Obstet Med 2017; 10: 10-15.

19. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. Who analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066-1074.

20. Sanisoğlu S, Uygur D, Keskinkılıç B, et al. Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey. J Obstet Gynaecol 2017; 37: 151-156.

21. Marshall AL, Durani U, Bartley A, et al. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol 2017; 217: 344.e1-344.e.6.

22. Khan T, Laul P, Laul A, Ramzan M. Prognostic factors of maternal near miss events and maternal deaths in a tertiary healthcare facility in India. Int J Gynaecol Obstet 2017; 138: 171-176.

23. UNFPA. Trends in Maternal Healthin Ethiopia: Challenges in achieving the MDG for maternal mortalityIndepth Analysisof the EDHS 2000- 2011. Addis Ababa: UNFPA; 2012.

24. Austin A, Gulema H, Belizan M, et al. Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study. BMC Pregnancy Childbirth 2015; 15: 74.

25. Admasu K, Haile-Mariam A, Bailey P. Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008. Int J Gynaecol Obstet 2011; 115(1): 101- 105.

26. Liabsuetrakul T, Peeyananjarassri K, Tassee S, Sanguanchua S, Chaipinitpan S. Emergency obstetric care in the southernmost provinces of Thailand. Int J Qual Health Care 2007; 19: 250- 256.

27. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091-1110.

28. Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol 2003; 101: 289-296.

29. Hasegawa J, Sekizawa A, Tanaka H, et al.; Maternal Death Exploratory Committee in Japan; Japan Association of Obstetricians and Gynecologists. Current status of pregnancyrelated maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 2016; 6: e010304.

30. Kahn ML. Eisenmenger's syndrome in pregnancy. N Engl J Med 1993; 329: 887.

31. Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116: 1302-1309.

32. Campbell KH, Savitz D, Werner EF, et al. Maternal morbidity and risk of death at delivery hospitalization. Obstet Gynecol 2013; 122: 627-633.

33. Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance-United States, 1991-1999. MMWR Surveillance Summary 2003; 52: 1-8.