Autopsy-Based Insights Into Maternal Mortality: A Retrospective Study From a Tertiary Care Center in North India

Maternal mortality remains a major public health concern, particularly in low- and lower-middle-income countries such as India. This retrospective, autopsy-based study was conducted to analyze the epidemiological characteristics, obstetric profile, and causes of maternal deaths at a tertiary care center in North India.

A total of 29 confirmed maternal death cases brought for medico-legal autopsy at the Advanced Autopsy Centre, All India Institute of Medical Sciences (AIIMS), Rishikesh, between October 2018 and January 2026 were included. Data were obtained from autopsy reports, clinical records, and inquest papers and analyzed using descriptive statistics.

The majority of maternal deaths occurred in women aged 20-30 years (n = 20, 69.0%), with a median age of 29 years. Most cases were from rural areas (n = 24, 82.8%) and belonged to lower middle (n = 14, 48.3%) and middle socioeconomic classes (n = 12, 41.4%). A considerable proportion of women had low educational status, with most attaining only middle or primary school education. The postpartum period accounted for the majority of deaths (n = 22, 75.9%), with all such deaths occurring within 10 days of delivery. Most women were referred from peripheral healthcare facilities (n = 24, 82.8%), and 41.4% (n = 12) were brought dead to the hospital. Direct obstetric causes accounted for 65.5% (n = 19) of maternal deaths, while 34.5% (n = 10) were due to indirect causes. Obstetric hemorrhage was the leading cause (n = 8, 27.6%), followed by sepsis (due to pregnancy-related infection) (n = 7, 24.1%) and pregnancy-induced hypertension (n = 4, 13.8%). Indirect causes included pulmonary tuberculosis (n = 2, 6.9%), pneumonia (n = 2, 6.9%), cerebrovascular thrombosis (n = 2, 6.9%), and cardiac conditions (n = 2, 6.9%).

The findings highlight critical gaps in timely referral, emergency transport, and postpartum care, along with the influence of socioeconomic and educational factors on maternal outcomes. Autopsy-based evaluations provide valuable insights into the accurate causes and determinants of maternal mortality. Strengthening healthcare infrastructure, improving referral systems, and addressing social determinants are essential to reducing preventable maternal deaths and accelerating progress toward achieving the Sustainable Development Goals (SDGs).