'70% maternal deaths in Karnataka were avoidable'

Bengaluru: Over 70 per cent of the maternal deaths that occurred in Karnataka between April 1 and December 31, 2024 could have been prevented, an interim audit report on maternal deaths in the state showed.

State Health Minister Dinesh Gundu Rao, who presented the 18-page interim report on Friday, made this observation. A total of 464 maternal deaths were audited during this period of nine months, with Bengaluru Urban (71), Ballari (38), Dharwad (35), Kalaburagi (33), and Belagavi (31), recording the highest. This total also includes the deaths of 18 women from other states.

About 80% of the deaths were among women aged 19 and 30 years and nearly 62.6% of the women who died during postnatal care had undergone a Caesarean section delivery. Seven girls aged below 18 also died during this period.

Following five maternal deaths in Ballari last November, the department constituted a 15-member expert committee to audit all maternal deaths to identify their likely causes. The Ballari maternal deaths were "most likely" due to endotoxins, and linked to sub-standard Ringer's Lactate solution from Paschim Banga Pharmaceuticals, they found.

Between April and December, they also found that Ringer's Lactate from the same company was linked to 13 other deaths -- four each in Raichur and Bengaluru Urban, three in Uttara Kannada, and one each in Yadgir and Belagavi.

The state's Maternal Mortality Rate (MMR) stands at 57 as of 2024-25, with Gundu Rao stating that the department's Rs 320-crore mission to bring preventable maternal deaths to zero is underway. They aim to bring the MMR down to match Kerala's 19 within two years.

Karnataka also reported 102 maternal deaths in the first three months this year, compared to 148 deaths in the corresponding period last year.

Among the many details in the audit, it was found that 319 women (68.75%) who died had a high-risk pregnancy. This included 153 women (33%) with a hypertensive disorder during pregnancy and 125 women (27%) who died due to a Haemorrhage. Sepsis (9%), cardiac issues (4%), infections (4%), pulmonary embolism (3%), were other causes identified.

Recommendations

The committee found that had risk factors been treated early, SOPs implemented, blood banks and other equipment kept ready, antenatal care improved, and natural births promoted, at least 70% of the deaths could have been avoided.

It listed 27 recommendations to reduce maternal mortality, including screening all pregnant women for high-risk factors during the first trimester, monitoring existing infections (HIV, syphilis, TB, hepatitis etc.), strengthening blood storage units and drugs and other equipment across the state, and mandating a hospital stay of three days for normal births and seven days after C-sections. 

"We are procuring FCM (Ferric carboxymaltose) injection for anaemia correction now. Between the second and seventh month, every antenatal mother must be counselled (by a trained health worker) monthly, twice in the eighth month, and weekly in the ninth month," said Gundu Rao.

Gundu Rao noted that while the state's MMR has been falling over the past five years, there is much that needs to be done to address "systemic failures". Of 464 deaths, 65.7% occurred in a government facility, 22.1% in private facilities, and nearly 10% in transit from a home to hospital or between hospitals. "In 10 cases, doctors' negligence has been established, and we have initiated an inquiry and submitted notices to them," he said.

Highlights - BoX
MMR in Karnataka:
2020-21: 77 (714 deaths, 9.30 lakh live births)
2021-22: 72 (635 deaths, 8.76 lakh live births)
2022-23: 62 (594 deaths, 9.54 lakh live births)
2023-24: 59 (550 deaths, 9.34 lakh live births)
2024-25: 57 (530 deaths, 9.31 lakh live births)

Quote - In 10 cases doctors' negligence has been established and we have initiated an inquiry and submitted notices to them. Health Minister Dinesh Gundu Rao