Revisiting "3 Delays Model" for Critical Analysis of Hypertensive Maternal Mortality in a Tertiary Care Centre

Hypertensive disorders in pregnancy are responsible for 14% of maternal deaths. Maternal mortality is not only due to medical disorder but also due to underlying social-cultural factors lead to delays in getting timely and appropriate intervention. This study aimed to analyse three delays, to identify socio-cultural, demographic and accessibility factors that contributed to maternal deaths due to hypertension in pregnancy.

It was a prospective observational study. Verbal autopsy was done for each maternal death that occurred due to hypertensive disorder. The "3 delay model" concept was used in collection and analysis of data for each maternal death. The Chi-square test (χ ²) and multivariable logistic regression model were used to accomplish the study objectives.

Out of 326 maternal deaths, 52 deaths were due to hypertensive disorders. Pulmonary oedema, eclamptic encephalopathy, sepsis and cerebrovascular accident were the major causes of maternal mortality. In thirty-nine (75%) type I delay was the most significant contributor of maternal death. Twenty-four (46.15%) and 14 (26.9%) had Type II/III delay. The reasons for level I delay were failure to recognize the danger signs, delay in decision-making, no ANC registration, Type II delay being lack of timely transport facility, type III delay being lack of adequate monitoring, delay in initiating treatment and substandard care in hospital were observed.

Socio-cultural and demographic factors significantly contribute to the direct or indirect medical cause of maternal death. Analysing these factors provide deep insight into the maternal death and will provide useful information for guiding the policy makers to take corrective actions and direct their programmes and policies such as strengthening referral networking, widespread coverage of healthcare facility and raising awareness of danger signs of pregnancy by reaching at grass root levels.