Analysis of Three Delays of Maternal Mortality in Federal Government Polyclinic Islamabad

Abstract

Background: Maternal mortality remains a global health concern, with disparities in outcomes persisting across regions and countries. The Three Delays Model, proposed by Thaddeus and Maine in 1994, has been instrumental in understanding the factors that contribute to maternal mortality. This model identifies three critical delays that, when present, can significantly impact maternal health outcomes. This analysis delves into each delay, examining their implications and proposing strategies for mitigation. Objective: To determine the current causes and trends in maternal death and analyze the contribution of three types of delays to maternal mortality. Study Design: Retrospective, Descriptive study. Settings: Obstetrics and Gynecology Department of Federal Government Polyclinic Islamabad Pakistan. Duration: January 2009 to December 2020. Methods: All the maternal deaths during this 12 years period were reviewed. All patient’s files and hospital records with the most comprehensive information available were reviewed and required information collected on a structured proforma. All the data of women who experienced maternal mortality, defined as death during pregnancy, childbirth, or within the first 42 days after childbirth, and who had sufficient data related to the Three Delays Model, was incorporated. For type of delay Thaddeus and Maine’s model was used. All the information was collected via structure proforma and analysis was done using SPSS version 26. Results: Total 67 maternal deaths encountered during the study period. Maternal mortality ratio was 77/100,000 live births. Mean age of the patients was 27.34+5.19 years and maximum deaths 44(65.7%) were in the age group of 21-30 years. Maximum patients 21(31.3%) were primigravida. Women were less educated 46(68.7%) of these had education below primary. Non booked accounted for 65.7%. Complications of Sepsis were leading cause in 13 (19.4%) of maternal deaths followed by hemorrhage in 11(16.4%) cases. Type I delay contributing in 36(53.7%) and type II 8(11.9%) and III delays in 6 (8.9%) cases. Conclusion: Maternal mortality ratio was observed to the 77/100,000 live births. Type I delay in terms of delay in Seeking help, poverty, family Taboos, ignorance of healthcare facility and lack of awareness observed to the most common. Furthermore, in type II delay the long distance and delayed referral were the common factors and in type III delay the commonest factors found inexperience of surgery and insufficient equipment.