Maternal Mortality Across a Multi-Hospital Health System in Saudi Arabia: A Retrospective Study (2016–2024)

Nuha Saeid,1 Roaa Alshabanah,1 Hadeel S Aldraihem,2 Humeda Suekit Ahmed,3 Azza Madkhali11Department of Obstetrics and Gynecology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; 2Quality and Safety Department, Women’s Health Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Physiology, General Medicine Practice, Batterjee Medical College, Aseer, Saudi ArabiaCorrespondence: Nuha Saeid, Department of Obstetrics and Gynecology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia, Email [email protected]: Maternal mortality remains a pressing global health challenge and is a vital indicator of healthcare quality. Despite improvements in Saudi Arabia, preventable maternal fatalities continue to occur, with insufficient research on regional disparities.Objective: This study seeks to assess the maternal mortality ratio (MMR) and its causes across five hospitals within the Ministry of National Guard Health Affairs in Saudi Arabia and evaluate it is main causes,thereby addressing a gap in maternal mortality data in the Gulf region.Methods: This retrospective, multicenter, descriptive study included all maternal deaths occurring during pregnancy or within 42 days postpartum between 2016 and 2024 across five National Guard hospitals in Riyadh, Jeddah, Madinah, Al-Ahsa, and Dammam. Data were extracted from hospital records and analyzed descriptively using SPSS version 28.Results: Eighteen maternal deaths were identified over the nine-year period, yielding an overall MMR of 6.2 per 100,000 live births (mean age at death 29.8 ± 6.3 years). MMR varied considerably by year, from 0.00/100,000 in 2017 to 37.5/100,000 in 2020. Pregnancy-related complications accounted for 50% of deaths (9/18), most commonly venous thromboembolism (66.7%). Non-obstetric causes included COVID-19 (16.7%), unknown cause (16.7%), brain tumor (5.6%), and myocarditis (5.6%). Most deaths occurred in women with parity 1– 3 (61.1%), split evenly between vaginal and caesarean delivery (50% each). Geographic variation was marked: Riyadh recorded deaths in most years with a peak in 2020; Dammam and Al-Ahsa each showed sporadic extreme spikes; Jeddah showed intermittent elevations; no deaths occurred in Madinah.Conclusion: The overall MMR at these hospitals is comparatively low to global figures, significant variations across different cities and years, alongside a notable number of deaths with unspecified causes, underscore the need for standardized mortality reviews, autopsy confirmations for suspected embolic deaths, and continuous targeted monitoring.Keywords: maternal mortality, cause of death, Saudi Arabia, pregnancy, hospitals