Contribution of Indirect Causes to Maternal Mortalities Based on a Methodological Approach to Clinical Epidemiology in Iran

Level of mothers’ literacy, pregnancy history of more than four times, residence in villages, lack of receiving intensive care during pregnancy, as well as inaccessibility to obstetric emergency services have been reported, in Iran and the world, as major factors for maternal mortality. Considering significance of identifying indirect causes of maternal mortalities, the present study was aimed to determine the contribution of indirect causes to maternal mortalities in Markazi province, Iran. This retrospective, descriptive-analytical study analyzes root causes and sentinel events through describing a case of maternal mortality reported in Markazi province. The data were gathered through interviews and documents’ investigation, and Bayesian analysis and calculation of conditional probability in Netica 5.08 software were used. Findings on a 36-year-old mother, in the 37th week of her third pregnancy and suffering from cardiomyopathy, indicated that lack of receiving prenatal care on time, insensitivity of health and medical personnel to pursuing the patient’s timely referrings according to Ministry of Health and Medical Education guidelines, lack of coordination and monitoring on the part of team of specialists responsible for the pregnant mother’s treatment in hospital, and indifference toward appropriate management of treatment were determined as indirect causes of the mother’s death. While cardiomyopathy was registered as direct cause of death, according to root cause analysis indirect causes had a 43% contribution to the mother’s death. Thus, planning for determination of major causes and eliminating indirect causes are very important for reducing maternal mortalities.