According to the National Health Mission and RCH guidelines in India, what is the most common cause of maternal mortality in the country?

Explanation

## Most Common Cause of Maternal Mortality in India **Key Point:** Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality in India, accounting for approximately 25–30% of all maternal deaths, despite being largely preventable. ### Epidemiological Context According to the latest Maternal Mortality Ratio (MMR) data and RCH program reports, the five leading causes of maternal death in India are: | Cause | Proportion (%) | Preventability | |-------|----------------|----------------| | Postpartum hemorrhage | 25–30 | Highly preventable | | Hypertensive disorders | 15–20 | Preventable | | Sepsis/puerperal fever | 10–15 | Preventable | | Anemia | 5–10 | Preventable | | Abortion-related | 8–12 | Preventable | **High-Yield:** PPH is the single most common direct cause of maternal death globally and in India. It is an obstetric emergency that can be rapidly fatal if not managed promptly. ### Why PPH Remains the Leading Cause 1. **Acute onset:** Occurs suddenly in the immediate postpartum period, often within the first 2 hours. 2. **Rapid decompensation:** Can progress to hypovolemic shock and death within minutes if untreated. 3. **Preventability gap:** Despite being preventable through active management of third stage of labor (AMTSL) and availability of oxytocics, many deliveries in India still occur without these interventions. **Clinical Pearl:** The RCH program emphasizes universal access to skilled birth attendance and availability of blood transfusion services specifically to reduce PPH-related mortality. **Mnemonic - CAUSES OF MATERNAL DEATH (India):** **PPH-SAN** - **P**ostpartum hemorrhage (most common) - **P**reeclampsia/eclampsia - **H**ypertensive emergencies - **S**epsis - **A**bortion complications - **N**utrition/anemia ### RCH Program Interventions - Promotion of institutional delivery - Training of ASHA workers and ANMs in recognition and first aid for PPH - Availability of injectable oxytocin and ergot alkaloids at all delivery points - Blood bank linkage and emergency transport systems [cite:Park 26e Ch 9]