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PubMed2001

[Analysis of maternal mortality in the Czech Republic in 1999].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 1999. DESIGN: Retrospective statistical and clinical analysis. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2; 2. Institute for Care of Mother and Child, Prague-Podoli. METHODS: We used database of 10 cases of maternal deaths in the Czech Republic during 1999 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total 10 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 1999. During the same period there were 89,471 live births in the Czech Republic, and Pregnancy-related mortality ratio (A + B + C) was 0.11@1000, i.e. 11.2 deaths per 100,000 live births. This is about 0.044@1000 worse than in 1998 (the last table demonstrates the development of maternal mortality during last 9 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A + B) was 0.10@1000, i.e. 10.1 deaths per 100,000 live births versus 6.63 deaths per 100,000 live births in 1998. Group A (specific risk--direct maternal mortality) contributed to adjusted maternal mortality by 6 maternal deaths and direct maternal mortality was 6.7 per 100,000 live births. Group B (non-specific risk--undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births. CONCLUSION: The increase of maternal mortality in 1999 and forensic impact of some cases indicate the necessity to respect established guideline for obstetrics and gynecology. Currently established complex prophylactic measures to prevent development of thrombembolic complications provede, if fully implemented, possibility to minimize these threatening and formerly very frequent situations leading to death. However, there is ongoing danger of hemorrhagic complications related to the DIC, which despite the modern therapy represent the major factor in maternal mortality and morbidity.

Adolescent↗

PubMed1999

Maternal mortality in Vietnam in 1994-95.

This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available.

Adolescent↗

PubMedDate not supplied

Obstetric first aid in the community--partners in safe motherhood. A strategy for reducing maternal mortality.

The unacceptably high levels of maternal mortality that are prevalent throughout the developing world are a product of many factors; most notably, these include nonexistent, inaccessible or inadequate facility-based emergency care, poorly developed referral linkages, predominance of home-based care by attendants and family members who are poorly equipped to respond to emergencies, and the complexities of problem recognition and decision making during emergencies leading to inappropriate or delayed action. This paper describes an innovative community-oriented strategy that has been designed to reduce maternal mortality and that targets women, families, and traditional birth attendants (TBAs) using two complimentary training interventions. The strategy reflects the authors' conviction that the training of professional and paraprofessional health workers in emergency care is essential, but that it must be complemented by the education and mobilization of families, communities, and TBAs who must, in turn, come to common perceptions on the need for and means of intervening to prevent a maternal death. Collaborating with partners in the US Agency for International Development-funded Primary Providers Training and Education in Reproductive Health Project. Special Project staff of the American College of Nurse-Midwives will lead development and testing of the strategy through operations research activities in selected countries.

Community Health Services↗

PubMed2005

The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.

OBJECTIVE: To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. METHODS: In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. RESULTS: During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p < 0.05). Maternal mortality before the war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p < 0.05). The increase in maternal mortality during the war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. CONCLUSIONS: During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).

Aortic Dissection↗

PubMed2000

Maternal mortality estimated using the Sisterhood method in Gulu district, Uganda.

A community-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. A total of 5522 adult respondents, randomly selected from 27 parishes, of the five counties in the district were interviewed. Between 1960-1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100,000 deliveries [95% confidence interval (CI) 421-839 per 100 deliveries]. The leading causes of maternal death were: haemorrhage 45.1%; obstructed labour 26.2%; puerperal sepsis 9.6%; anaemia 2.2%; AIDS 2.2%; and gunshot wounds (GSW) 1.0%. Factors associated with maternal mortality included: age--31.8% of the mothers who died were below 20 years; education--57.1% had no formal education; 65% of the mothers had delivered at home, 50.6% had been attended to by untrained traditional birth attendants (TBAs), while 37.8% were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100,000 deliveries. Most maternal deaths (80.9%) were due to preventable causes, being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the high maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services, motor and bicycle be made available at the district and community levels. At a national level the security situation should be improved in the district.

Adolescent↗

PubMed1990

Maternal mortality audit in a Zimbabwean province.

A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. The main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.

Cesarean Section↗

PubMedDate not supplied

Maternal mortality in Matlab, Bangladesh: 1976-85.

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

Adolescent↗

PubMedDate not supplied

Assessing the role of family planning in reducing maternal mortality.

It is widely believed that family planning has important benefits for both maternal and child health. Despite this, little work has been done to quantify the potential effect of family planning in reducing maternal mortality. This paper assesses the impact of family planning in averting maternal deaths, and discusses the overall ability of risk strategies to address the bulk of maternal mortality. The practical difficulties of providing effective contraception to populations with high maternal mortality are addressed, and the need for maternal health care services as an adjunct to useful family planning programs is emphasized. Although family planning cannot by itself cause a substantial reduction in risk of pregnancy, the combined strategies of general fertility reduction, abortion services, and family planning for high-risk groups might effectively address about half of all maternal mortality in the developing world. Pregnancy and delivery care have the potential for saving large numbers of lives with appropriate interventions. It is concluded that reproductive risks can be reduced only by preventing unwanted pregnancies and protecting maternal health during wanted ones.

Abortion, Legal↗

PubMed2004

Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study.

OBJECTIVE: To assess the maternal mortality ratio in maternity units of reference hospitals in large west African cities, and to describe the distribution of complications and causes of maternal deaths. STUDY DESIGN: Prospective descriptive study in twelve reference maternities located in three African countries (Benin, Ivory Coast, Senegal). Data (clinical findings at hospital entry, medical history, complications, type of surgery, vital status of the women at discharge) were collected from obstetrical and surgical files and from admission hospital registers. All cases of maternal deaths were systematically reviewed by African and European staff. RESULTS: Of a total of 10,515 women, 1495 presented a major obstetric complication with dystocia or inappropriate management of the labour phase as the leading cause. Eighty-five maternal deaths were reported, giving a global hospital-based maternal mortality ratio of 800/100,000. Hypertensive disorders were involved in 25/85 cases (29%) and post-partum haemorrhage in 13/85 cases (15%). Relatively few cases (14) of major sepsis were reported, leading to three maternal deaths. CONCLUSION: The results of this multicentre study confirm the high rates of maternal mortality in maternity units of reference hospitals in large African cities, and in addition to dystocia the contribution of hypertensive disorders and post-partum haemorrhage to maternal deaths.

Adult↗

PubMed2005

[Maternal mortality. A necessary revision for its acknowledgement, its medical and social causes and a proposal of actions to be undertaken for its reduction].

Maternal mortality is a portrait not only related to maternal health and to the characteristic of the medical services, but also to the social, cultural and political conditions of a given society. It occurs 120 billons pregnancy every year and almost 600.000 women die because of causes related to pregnancy, delivery or puerperal diseases, 95% of those deaths occur in underdeveloped countries. In Swiss, Finland, Canada and Holland, 4 deaths are registered, while in Somalia and Nigeria 1000 death are reported for each 100.000 alive new baby (NV), Meanwhile, in Latin America and the Caribe, 190 death are reported, almost 23.000 women death every year, which clearly shows a great difference between countries. These differences also occur within a given country, as in Argentina, where the prevalence is 44 for each 100.000 NV, Buenos Aires has 9 while Formosa as 177. We pointed out that nonqualified medical services is a very important fact on the above mentioned maternal death, because of the lack of attention of the sepsis, the hemorrahages, the prolonged delivery work and the eclampsia. But abortion is the most important cause of maternal death. We mentioned the social, educational and sanitary facts of illegal abortion. In developed countries pre eclampsia is the main factor. It is mentioned the strategies of the International Conference "Maternity without Risk" carried out in Nairobi in 1987 and the Task Force Inter Regional Agency for the Reduction of Maternal Mortality. 2004 as a good recommendation to be taken into account in order to diminish maternal mortality. We propose to highlight the use of the Maternal Mortality Committee and the application of the Epidemiological Survey System, in order to diminish maternal mortality and some particular ones for the prevalent pathologies and it is concluded that maternal mortality could diminish not only with better sanitary conditions, but also with equal social conditions, specially in underdeveloped, countries where this situation is a real problem.

Cause of Death↗

PubMed1999

Maternal mortality, women's status, and economic dependency in less developed countries: a cross-national analysis.

While much has been written about the medical, economic, and social causes of cross-national differences in some mortality related phenomena such as in life expectancy and infant mortality, much less attention has been given to maternal mortality, the focus of the present study. In the studies of maternal mortality that have been done, there has been very little effort to assess the potential relevance of the gender stratification and dependency theory perspectives. Using lagged cross-sectional and path analysis with a sample of 79 less developed countries, this article focuses on the impact of predictors linked to three theoretical perspectives - modernization, economic dependency, and gender stratification. We find that women's status, as measured by indicators such as level of education relative to men, age at first marriage, and reproductive autonomy, is a strong predictor of maternal mortality. We find that economic dependency, especially multinational corporate investment, has a detrimental effect on maternal mortality that is mediated by its harmful impacts on economic growth and the status of women. We also find support for developmental theory, a variant of modernization theory.

Adolescent↗

PubMed1997

Underreporting of maternal mortality in The Netherlands.

OBJECTIVE: To establish the actual number of maternal deaths in The Netherlands by determining the degree of underreporting. METHODS: We conducted a nationwide, retrospective cross-check of the three available maternal mortality registration systems and issued a questionnaire to senior obstetricians in all hospitals during the years 1983-1992. RESULTS: The officially reported maternal mortality rate during the study period was 7.1 per 100,000 live births (133 maternal deaths per 1,862,985 live births). After completion of the study, our data indicate that the rate should be at least 9.7 per 100,000 live births (180 maternal deaths). Early pregnancy and indirect deaths were more likely to be underreported than direct deaths during labor and the puerperium. Failure to register the recent pregnancy on the death certificate was a frequent problem. Misclassification was particularly evident for cerebrovascular disorders, cardiovascular disorders, and eclampsia. CONCLUSION: The level of underreporting of maternal mortality in The Netherlands was estimated at 26%. The pregnancy status of women should be registered on death certificates. Officially reported maternal mortality rates are unreliable and international comparisons using these data thus are less meaningful.

Cross-Sectional Studies↗

PubMed1994

Maternal mortality in Sweden, 1980-1988.

OBJECTIVE: To assess recent maternal mortality in Sweden according to the different definitions of the eighth, ninth, and tenth editions of the International Classification of Diseases (ICD). METHODS: All maternal deaths in Sweden during 1980-1988 were sought in the Medical Birth Registry and in the Registers of Births and Deaths. Hospital records and autopsy reports were requisitioned. RESULTS: According to ICD-9, the maternal mortality ratio in Sweden for 1980-1988 was 7.4 per 100,000 live births. Of the 58 deaths, 36 were direct maternal deaths. Embolism, hemorrhage, preeclampsia, and infection were the predominant causes in the direct cases. Advanced age was the most pronounced risk factor. Suboptimal standard of care was a contributing cause in almost one-third of the direct maternal deaths. Accidental or incidental deaths, including suicide, accidents, and pregnancy-related deaths, added six cases. There were 76 late maternal deaths, occurring 43-365 days postpartum. Malignancy, stroke, and heart disease were the predominant causes. After malignant disease, suicide constituted the leading cause of pregnancy-related deaths within 1 year of delivery. CONCLUSIONS: Regular reviews of maternal mortality are still important in a country with a low rate of maternal deaths. The new classification of maternal deaths allows a better international comparison of mortality risks. Continuous surveillance of maternal deaths and pregnancy-related deaths requires record linkage of birth and death registrations.

Adult↗

PubMedDate not supplied

Maternal mortality in seven districts of Uttar Pradesh--an ICMR task force study.

Maternal mortality is a major health and development concern. The available information on maternal mortality in rural India is inadequate and scanty. This study presented maternal mortality data from the demographically and developmentally (including for health) poor performing state of Uttar Pradesh. A descriptive, cross-sectional survey was conducted utilizing a stratified cluster sampling design between 1989-90 in eight districts of Uttar Pradesh. Four good performing districts namely, Agra, Farrukhabad, Ghaziabad and Badaun from the western region and four poor performing districts from the eastern region namely, Gorakhpur, Basti, Varanasi and Pratapgarh were chosen. A door-to-door household interview survey was carried out in the selected villages covering a population of 11.67 lakhs in 889 villages. Maternal mortality rates during 1989 ranged between 533745 per 100,000 live births except in Ghaziabad district where the rate was as low as 101 per 100,000 live births. The rate in Eastern U.P. was higher (573 per 100,000 live births) as compared to that in Western U.P. (472 per 100,000 live births). A total of 286 maternal deaths were reported during the study period. The direct obstetric causes accounted for 55.7% of maternal deaths with haemorrhage (26.4%) being the most prevalent. Anaemia and jaundice (17.4%) were the most prevalent indirect causes of maternal deaths. Most of the maternal deaths could have been prevented if timely medical care was available.

Adolescent↗

PubMedDate not supplied

Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002.

BACKGROUND: Maternal mortality in Afghanistan is uniformly identified as an issue of primary public-health importance. To guide the implementation of reproductive-health services, we examined the numbers, causes, and preventable factors for maternal deaths among women in four districts. METHODS: We did a retrospective cohort study of women of reproductive age (15-49 years) who died between March 21, 1999, and March 21, 2002, in four selected districts in four provinces: Kabul city, Kabul province (urban); Alisheng district, Laghman province (semirural); Maywand, Kandahar province (rural); and Ragh, Badakshan province (rural, most remote). Deaths among women of reproductive age were identified through a survey of all households in randomly selected villages and investigated through verbal-autopsy interviews of family members. FINDINGS: In a population of 90 816, 357 women of reproductive age died; 154 deaths were related to complications during pregnancy, childbirth, or the puerperal period. Most maternal deaths were caused by ante-partum haemorrhage, except in Ragh, where a greater proportion of women died of obstructed labour. All measures of maternal risk were high, especially in the more remote areas; the maternal mortality ratio (per 100,000 livebirths) was 418 (235-602) in Kabul, 774 (433-1115) in Alisheng, 2182 (1451-2913) in Maywand, and 6507 (5026-7988) in Ragh. In the two rural sites, no woman who died was assisted by a skilled birth attendant. INTERPRETATION: Maternal mortality in Afghanistan is high and becomes significantly greater with increasing remoteness. Deaths could be averted if complications were prevented through optimisation of general health status and if complications that occurred were treated to reduce their severity--efforts that require a multisectoral approach to increase availability and accessibility of health care.

Adolescent↗

PubMed1993

[Estimate of maternal mortality in a rural area of Niger: use of the indirect sisterhood method].

Maternal mortality remains one of the major public health problems nowadays. Each year, all over the world, half a million women die of pregnancy-related complications most of which could be avoided. In spite of enormous efforts at handling this problem, the results have been small. In many countries, the extent of the problem is virtually unknown for lack of reliable birth and mortality data. Where vital statistics are incomplete or non-existent, one should have recourse to other sources of information. In reaction to the classic, yet inadequate methods of collecting information, indirect techniques for estimating maternal mortality have been developed. One of these procedures is the sisterhood method: using this technique, researchers are able to deduce indicators of maternal mortality based on the proportion of sisters, who, once reached childbearing age, survived or died during pregnancy, childbirth or postpartum. The authors tested this method in Niger in a rural area with difficult access to primary health care. They noted a maternal mortality rate of 1,050 every 100,000 live births. This practical and simple method of estimating maternal mortality in a given area, at a relatively low cost, could readily be incorporated into routine medical activities.

Adolescent↗

PubMed1999

[Maternal mortality at the Gynecologic-Obstetric Hospital of the Western National Medical Center, Mexico. A 12-year review].

The aim of this study is to present the analysis of the leading causes of mortality found in all the cases of maternal death at the Hospital de Ginecobstetricia (HGO) and Hospital de Especialidades (HE) del Centro Médico Nacional de Occidente (CMNO), during a period of 12 years, to achieve a winder view and to find a solution to reduce maternal mortality (MM). We reviewed files and reports of the maternal mortality committee of 151 women who were hospitalized and died at the HGO and HE del CMNO in Gudalajara, Jalismo, México, between January first, 1985 and December 31, 1996. During this period the maternal death ratio was 64 per 100,000 live births. The main cause of maternal death was toxemia 25%, follow by hemorrhage 23%, pulmonary thromboembolism 16%, infection 13%, and anesthetic complications 6%. 73% were foreseen deaths and 23% were unforeseen deaths. At the patients arrival to the hospital 37% were avoidable deaths. 66% were direct obstetric deaths and 34% were avoidable deaths. 66% were direct obstetric deaths and 34% were indirects. In 50% of the cases the end of pregnancy was done by cesarean section. The professional responsibility existed in the 72% and the hospitalary in the 23%. We made an analysis related factors and we propose strategies to diminish the maternal mortality.

Female↗

PubMed2004

Racial disparity in infant and maternal mortality: confluence of infection, and microvascular dysfunction.

OBJECTIVES: Racial disparities in infant and maternal mortality have been attributed to the unique stresses faced by Black women in the United States, but the underlying pathophysiological pathways are poorly understood. This paper reviews the literature related to potential causes of racial disparities in infant and maternal mortality. METHODS: A review of the literature from 1966 to 2003 was conducted using a series of searches of Medline, obstetrical journals, and bibliographies. The review focused on potential contributing pathophysiological factors to infant and maternal mortality. RESULTS: Racial disparities in neonatal mortality largely result from excess rates of preterm birth, fetal growth restriction, and neonatal sepsis while racial disparities in maternal mortality reflect greater prevalence and/or severity of cardiovascular/preeclamptic complications, hemorrhage, and infection among African American women. A large body of epidemiological, placental, and pathophysiological evidence suggests that racial disparities in these disparate outcomes result from two distinct, but potentially converging, pathways: infection and vascular. Racial disparities in intrauterine infection and microvascular dysfunction during pregnancy may result from a constellation of environmental and intergenerational risk factors including psychosocial stress, douching, bottle-feeding, lead exposure, diet, intrauterine growth, and genes. CONCLUSIONS: Disparities in infant and maternal mortality appear to reflect a confluence of infections and microvascular dysfunction during pregnancy among African American women. Interventions that target these conditions offer promise for reducing racial disparities in these critical outcomes.

Black or African American↗