Abstract
Objective: To assess the magnitude, causes and substandard care factors responsible for the third
delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil
Hospital, Karachi.
Methods: This Cross-sectional, retrospective study was carried out on 152 mothers who died
over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all
maternal deaths were reviewed from death registers and were studied for substandard care
factors which could have been responsible for the third delay of maternal mortality.
Results: The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was
29±6.49 years and mean parity was 3.24±3.25.The main causes of death were hypertensive
disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152
(10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases.
Substandard care factors were present in 76.7% of patients, which included inappropriate
management of pulmonary edema, delay in arranging blood for hemorrhaging patients and delay
in surgical intervention.
Conclusion: Substandard care factors were present in majority of cases of maternal deaths.
Improvement of maternity care services in Civil Hospital Karachi is needed on an urgent basis.
(Rawal Med J 2007;32:163-167).

Key words: Maternal deaths, abortion, puerperal sepsis, PPH.