Why do mothers die in Dakahlia, Egypt?

Aim: To investigate the causes of maternal mortality in the Dakahlia Governorate in Egypt. Methods: A confidential enquiry for each case of maternal mortality during the years 2004-2005 was carried out. Results: One hundred and seventy-nine maternal deaths were reported, giving a maternal mortality rate (MMR) of 71.3/100 000 live births. 140 (78.2%) women died due to direct obstetric causes, 24 (13.4%) due to indirect causes and 15 (8.4%) due to accidental or unexplained causes. 44 (24.6%) women died during or following delivery by cesarean section and 91 (50.8%) during labor or within 24 h following delivery. Complications during cesarean delivery, postpartum hemorrhage and hypertensive disorders were the leading causes of maternal mortality. Death due to substandard care was encountered in 85% of cases. Obstetricians were responsible for 51% of causes of avoidable maternal death. Conclusion: Maternal mortality in Dakahlia, although declining, is still relatively high. To further reduce maternal mortality, deliveries should be conducted at well-equipped hospitals.