Mosquito-borne infections have emerged as one of the primary causes for maternal deaths in Mumbai. Of the 276 maternal deaths reported in Mumbai between 2013 and 2014, 14, or 5%, were caused by dengue and malaria, according to the civic body's maternal death committee's review that analyses maternal deaths in city hospitals on a monthly basis.
In 2013, the civic body reported 927 dengue cases and 11 dengue-related deaths. However, this figure does not include maternal deaths owing to dengue. “This is the first time that we have created a separate category for dengue-related maternal deaths. Earlier, we did not have such deaths,” said a senior doctor from the civic body.
Dengue-related maternal deaths have surpassed anaemia (person has low haemoglobin levels), which was considered to be a major cause of such deaths in Mumbai. While 4% of maternal deaths were attributed to dengue infection, anaemia caused 1% of the deaths.
Experts said hospitals in the city treat a large number of patients, who are referred from outside city limits and hence many maternal deaths are of women who are not Mumbai residents.
An international study on ‘pregnancy and dengue’, published in 2013 by researchers from Brazil, concluded that pregnant women have an increased risk of severe dengue infection and dying of it. “We lost a 26-year-old pregnant woman and her child who came to our hospital in a critical state. Her condition was already deteriorating, requiring us to put her on ventilator support,” said Dr Ashok Anand, professor of gynaecology at JJ Hospital. “If a pregnant woman contracts dengue or malaria during pregnancy, the chances of the foetus surviving are almost zero.”
Doctors said pregnancy lowers a woman’s immunity, and thus the disease progression is severe and faster. “Owing to delayed diagnosis of infection in pregnant woman, the treatment becomes challenging and at times even treatable conditions such as dengue and malaria turn fatal,” said Dr PK Shah, professor of gynaecology at KEM Hospital.
Apart from vector-borne infections, tuberculosis and hepatitis E (jaundice) were detected as the cause of mortality among 15% pregnant woman, while deaths followed by eclampsia (pregnancy-induced hypertension that leads to convulsions) was found to be fatal in 7% cases.
Civic officials said pre- and post-partum haemorrhage (bleeding) during child birth and sepsis (infection) are still the top causes of maternal deaths. These can be reduced by improving existing health infrastructure. “Infections such as TB, hepatitis E as well as malaria and dengue are preventable causes that the patient herself has to arrest. Women who are aware that they are suffering from tuberculosis or heart disease should conceive after they are treated of the conditions, to avoid complications during child birth,” said a doctor from the civic body.
Causes of Maternal Deaths:
Sepsis - 10.5 %
Burns - 10.5%
Haemorrhage - 9.4%
Hepatitis E - 7.6%
TB - 7.6%
Eclampsia (seizures) - 7.2%
Heart disease - 4.3%
Anemia - 1.8%
Malaria - 1.4%
Dengue - 3.6%
Others – 36.1%