Maternal mortality is a health major problem worldwide. Maternal Mortality Rate (MMR) is one indicator of women's health degree. MMR is also one of the targets set in the millennium development goals (which is goal 5), with the aim of improving maternal health where the target to be achieved by 2015 is to reduce the risk of maternal mortality by 75% [1]. In 2000, more than 500,000 women died from complications related to pregnancy or childbirth. Nonetheless, 99% of these deaths are actually preventable, according to the United Nation Population Fund's (UNFP) report “States of World Population 2005” [2]. Apart from that, the highest number of maternal deaths was also found in developing countries for example Africa and Southeast Asia [1] .

Globally, approximately 80% of maternal deaths are due to complications arising during pregnancy, childbirth, or puerperium with bleeding is the main cause of maternal death [3]. In 2007, the MMR in Indonesia was approximately 228 out of 100,000 live births. The problems of death that occur are often the result of bleeding, pregnancy poisoning accompanied by seizures, abortion and infection. In addition to medical problems, high maternal mortality is also due to issues of gender inequality, cultural values, the economy and the low attention of men to pregnant and giving birth mothers. On that side, there are other factors, namely abortion, prolonged labor, embolism, complications during the puerperium and others [4,5].

This study aims to determine the description of maternal mortality focused on perinatal mortality and some of its obstetric complications at Hasan Sadikin General Hospital, Bandung, West Java, Indonesia in 2022.

This study used a descriptive design, conducted from June to November 2022. The research was conducted by collecting secondary data from medical records at the Department of Obstetrics and Gynecology at Hasan Sadikin Central General Hospital Bandung, West Java, Indonesia. The sample criteria in this study were women aged 20-35 years. Sampling was done by total sampling method [6]. Data on factors causing maternal death such as antepartum bleeding, prolonged labour, postpartum hemorrhage, hypertension, caesarean section, infection and other diseases/complications). Descriptive univariate analysis was performed on research data presented by frequency and percentage. This study was approved by the Ethics Committee of Hasan Sadikin Central General Hospital Bandung, West Java, Indonesia.

In this study, 2297 patients were included. Descriptive data on causes of maternal death at the Hasan Sadikin General Hospital, Bandung, West Java, Indonesia in 2022 is presented in Table 1.

In this study, it was found that the highest percentage of maternal deaths occurred in the antepartum hemorrhage category, with 28 out of 227 cases (12.33%). Meanwhile, maternal deaths were also caused by other events with the highest percentage order being hypertension during pregnancy (4.49%), postpartum hemorrhage (4.42%), surgical complications (3.24%), prolonged labor (2.49%) and other diseases or complications (1.45%).

This study shows that the highest percentage of maternal deaths at the Hasan Sadikin General Hospital in Bandung, West Java, Indonesia in 2022 is antepartum hemorrhage with a total of 28 out of 227 cases (12.33%). Antepartum bleeding is bleeding in pregnancies over 20 weeks which is generally caused by placenta previa, placental abruption and uterine rupture [4,5,7]. In a study conducted in Africa from 2008-2010, by Fawcus stated that maternal mortality caused by bleeding amounted to 688 out of 100,000 live births in Africa [8]. In another study, by Jogchum Beltman in Malawian, maternal deaths caused by antepartum hemorrhage amounted to 2 of 37 cases found.

In addition, the highest percentage of maternal deaths in this study was also caused by hypertension in pregnancy (4.49%). Hypertension in pregnancy alone caused 24 deaths out of 534 cases. In another study by Elvira Zanette conducted in Brazil on causes of maternal death, deaths caused by hypertension in pregnancy amounted to 42 out of 140 cases. Hypertension in pregnancy itself is blood pressure higher than 140/90 mmHg caused by pregnancy itself which has the potential to cause serious disturbances in pregnancy, usually occurring at the age of 20 weeks of gestation [9,10].

Table 1: Descriptive of Maternal Death Etiology

Furthermore, postpartum hemorrhage has the third largest percentage. Postpartum hemorrhage alone caused 31 deaths from 701 cases (4.42%). In another study conducted by Ndola Prata in Bangladesh and Leena Wadhwa in India, there were maternal deaths caused by postpartum hemorrhage in 54 of 110 cases and 25 of 37 cases of maternal death were found. Postpartum bleeding itself is bleeding that occurs immediately after the mother gives birth, especially the first two hours after giving birth. Another definition states postpartum hemorrhage is blood loss of more than 500 ml through the birth canal that occurs during the first 24 after delivery [4,11].

Based on the above conclusions, the largest percentage of causes of maternal death at the Hasan Sadikin General Hospital in Bandung, West Java, Indonesia in 2022 will occur in the antepartum hemorrhage category, where the maternal mortality rate in this category is 28 out of 227 cases found (12, 33%). The above results show the need to anticipate maternal mortality, for example by carrying out early detection of disease complications that can cause maternal death and conducting counseling or training to medical personnel in remote areas about dealing with maternal mortality based on the causes of death that are often experienced.

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2. World Health Organization. Reproductive Health Indicators for Global Monitoring: Report of the Second Interagency Meeting, WHO Geneva, 17–19 July 2000. World Health Organization, 2001.

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11. Zanette, E. et al. “Maternal near miss and death among women with severe hypertensive disorders: A Brazilian multicenter surveillance study.” Reproductive Health, vol. 11, 2014, p. 4. https://doi.org/10.1186/1742-4755-11-4.