Covid-19 leading cause of maternal death in Mumbai for second year in a row

In 2020, a total of 197 maternal deaths were reported of which 29 or 14.7 per cent were attributed to Covid-19. This number slightly dropped to 190 in 2021, possibly due to fewer deliveries during the pandemic. Deaths due to Covid-19 increased to 43 or 22.6 per cent of the total maternal fatalities in Mumbai, according to an RTI filed by activist Chetan Kothari.

Maternal deaths are deaths from any cause related to or aggravated by pregnancy or its management excluding accidental or incidental causes during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

An analysis of the ‘maternal death causes’ showed that in 2021, after Covid-19, 22 or 11.5 per cent of mothers died from sepsis — a life-threatening organ dysfunction caused by a dysregulated host response to infection. This is followed by haemorrhage from which 21 or 11 per cent of mothers succumbed. Tuberculosis (TB) has become the fourth leading cause of maternal deaths. In 2020, nine mothers died of TB and 16 in 2021, contributing to 8.4 per cent of the total deaths.

In 2019, 257 mothers lost their life due to complications during and following pregnancy and childbirth of which 32 or 12.4 per cent were from haemorrhage and 28 or 10.8 per cent were from sepsis. Hepatitis accounted for 27 or 10.50 per cent of the deaths and another 19 or 7.3 per cent died of acute respiratory distress syndrome.

Pregnant women have a weak immune system and they have many physiological changes, say doctors. This may make them more susceptible to Covid-related complications.

“Globally, it has been observed that during pregnancy, the immunity level comes down among women, which makes them more susceptible to the infection. So, women with co-morbid health issues develop further complications,” said Dr Ashok Anand, head of the department, obstetrics and gynaecology, Sir JJ Group of Hospitals, Mumbai.

A study conducted by the Indian Council of Medical Research (ICMR)-National Institute for Research in Reproductive Health (NIRRH) last year revealed that the case fatality rate (CFR) in pregnant women with Covid-19 was 0.8 per cent in Maharashtra. The study noted a higher CFR in Pune (9/853, 1.1 per cent) and Marathwada (4/351, 1.1 per cent) regions as compared to Vidarbha (9/1155, 0.8 per cent), Mumbai Metropolitan (11/1684, 0.7 per cent), and Khandesh (1/160, 0.6 per cent) regions.

The cause of death was respiratory failure, kidney failure, cardiac failure and many had multi-organ involvement. Women with anemia, tuberculosis and diabetes mellitus had a higher risk of death due to Covid-19.

Doctors voiced the need for vaccination among pregnant woman which can reduce the severity of infection. “In the second wave, we have witnessed more health complications among infected pregnant mothers. So, we have been counseling pregnant women coming to us for vaccination but still there is hesitancy among them,” said Dr Akash Shukla, gastroenterologist from Lokmanya Tilak General hospital, Sion.