Audit of Early and Late Maternal Deaths in Georgia: Potential for Improving Substandard Obstetric Care

Abstract

Introduction

Quality of care is an important factor in reducing preventable maternal deaths, yet it is a significant challenge in many countries. Substandard and poor quality of care is the leading factor in two-thirds of maternal deaths in European countries. Our study investigated the deaths of all women of reproductive age in 2012 in Georgia. The aim was to define the underlying causes of maternal deaths and to identify the factors in women’s care which contributed to the fatal outcomes.

Methods

A national Reproductive Age Mortality Survey was conducted in Georgia in 2014–15. Data from multiple sources was triangulated to identify all deaths of women of reproductive age. This was followed by verbal autopsy diagnoses. Each case of early and late maternal death was investigated through interviews and medical record reviews at the last medical facility providing care for the deceased woman. A specialist panel reviewed and assigned underlying causes of death, assessed the management of each woman’s condition, and identified elements of suboptimal care.

Results

We identified a total of 23 maternal deaths, including 15 (65%) early and eight (35%) late deaths. The maternal mortality ratio was 26.3 per 100 000 live births. The four leading causes of early maternal deaths were: sepsis, hemorrhage, embolism, and pregnancy-induced hypertension. Embolism and sepsis were the direct causes of the eight late maternal deaths. Cancer, tuberculosis, and postpartum suicide constituted the indirect causes of death. Improvements in care which would have made a difference to the outcomes were identified in 87% of early maternal deaths and 67% of late maternal deaths due to direct obstetric causes.

Discussion

Delayed recognition and inappropriate management of maternal complications were common across almost all cases studied. The findings from Georgia highlight the conclusion that most maternal deaths were preventable and that improvement in obstetric care is urgently required.

Keywords:

• maternal mortality
• late maternal death
• cause of death
• quality of care
• maternal death preventability

Ethics

The study was conducted in accordance with the Helsinki Declaration.

Acknowledgments

The authors thank the US Agency for International Development (USAID) for funding this study and Letten Foundation for providing financial support for this work. The authors are also grateful to the staff of NCDC&PH and all other contributors to this study. The funding agency had no role in the study design and data collection, data analysis, or preparation of this manuscript.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

Dr Nino Berdzuli reports grants from United States Agency for International Development and that the US International Development Agency funded the Reproductive Age Mortality Survey study and data from this study were used to analyze maternal deaths, during the conduct of the study. The authors declare that they have no other potential conflicts of interest for this work.