Investigating the causes of maternal mortality in Razavi Khorasan based on forensic medical records during the years 2015 to 2022.

Background: Maternal mortality is among the main indicators of health in nations. Identifying the causes of maternal mortality is crucial in designing preventive interventions. Therefore, this study aimed to evaluate the causes of maternal mortality during 8 years.

Methods: This descriptive-analytical study was conducted on the archived cases of maternal mortality in the Forensic Medicine Department of the Khorasan Razavi Province between March 2013 and March 2022, but as no data was available for the first two years, maternal mortality data for 8 years was evaluated. Demographic characteristics, midwifery data, pregnancy care method, pregnancy care and delivery agent, insurance type, and confirmed cause of death were compared between the first and last five-year periods of the study.

Results: Overall, 250 cases of maternal mortality were identified in the study period. The prevalence of indirect and unrelated causes of maternal mortality was significantly higher in the last four-year period compared to the first four-year period (p < 0.001). The most common direct causes of maternal mortality in both periods were postpartum hemorrhage, eclampsia and gestational hypertension complications; and postpartum infection. Coronavirus disease 2019 (COVID-19) was the most common cause of maternal mortality in the last four-year period but the other common indirect causes of maternal mortality (cardiovascular disease and pulmonary embolism) were similar between the two periods. The most common unrelated cause of maternal mortality was accidents.

Conclusions: Postpartum maternal mortality was higher than intrapartum period. Bleeding was still the main cause of maternal mortality. Despite the progress in prenatal care, it is necessary to improve intrapartum and postpartum quality of care.