Among the following, the most common cause of maternal mortality in India is:

Explanation

## Most Common Cause of Maternal Mortality in India **Key Point:** Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in India, accounting for approximately 27–30% of all maternal deaths, followed by hypertensive disorders and unsafe abortion. ### Maternal Mortality Landscape in India | Cause | Proportion of MMR | Key Features | |-------|-------------------|---------------| | **Postpartum hemorrhage** | 27–30% | Preventable with active management of 3rd stage labor, uterotonic drugs | | **Hypertensive disorders** | 15–18% | Preeclampsia, eclampsia; preventable with antenatal screening | | **Unsafe abortion** | 8–13% | Illegal/clandestine procedures; preventable with comprehensive reproductive health | | **Anemia/malnutrition** | 5–10% | Indirect cause; worsens outcomes in hemorrhage and infection | | **Infection/sepsis** | 10–15% | Puerperal sepsis, chorioamnionitis | | **Embolism** | 5–8% | Amniotic fluid embolism, thromboembolism | **High-Yield:** The **WHO/UNICEF/UNFPA/World Bank Group estimates** and **India's Sample Registration System (SRS)** consistently identify PPH as the #1 direct obstetric cause of maternal death in India. ### Why PPH Dominates 1. **High incidence:** Occurs in 2–5% of all deliveries in India 2. **Rapid deterioration:** Can lead to shock and death within hours if untreated 3. **Preventable:** Active management of third stage of labor (AMTSL) with oxytocin, ergot alkaloids, or misoprostol reduces PPH by ~40% 4. **Facility gap:** Many deliveries occur in non-facility settings without access to blood transfusion or surgical intervention ### Clinical Pearl - **AMTSL components:** Uterotonic (within 1 min of delivery), controlled cord traction, uterine massage - Anemia is an **indirect cause** that worsens outcomes in PPH; it is not the primary cause of death - Unsafe abortion contributes significantly to MMR in India but ranks below PPH in frequency ### Prevention & Management - Universal AMTSL at all deliveries - Skilled birth attendants trained in PPH recognition and management - Access to emergency obstetric care (EmOC) with blood transfusion capability - Prophylactic oxytocin in high-risk pregnancies **Mnemonic:** **CHEAT** — Common causes of maternal death in India: **C**omplication of abortion, **H**emorrhage (PPH), **E**clampsia, **A**nemia (indirect), **T**hromboembolism. PPH is the top direct cause. [cite:Park 26e Ch 8; WHO Maternal Mortality Estimates 2023]