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PubMed2004

An analysis of the determinants of maternal mortality in sub-Saharan Africa.

OBJECTIVE: To establish what population characteristics affect the high maternal mortality rate in the sub-Saharan Africa region and to propose possible solutions to reduce this rate. METHODS: This study is a secondary analysis of existing data sources from the World Bank, the World Health Organization (WHO), as well as direct and indirect sources from UNAIDS, the United Nations, Demographic and Health Surveys (DHS), Macro International, and national statistical offices. Instead of looking at continentwide or individual nation models, it develops a regional model. Sociodemographic population variables are used as independent variables to predict the dependent variable, maternal mortality. Additionally, a new country-specific political stability independent variable is introduced into the model. Data from 28 sub-Saharan African countries are used. Bivariate correlations are used to establish associations among the variables, whereas cross-tabulations, using Kendall's tau-c values, and regression lines are used to establish impacts. RESULTS: In the sub-Saharan Africa region, births attended by skilled health personnel and life expectancy at birth strongly correlate with maternal mortality. Gross national product (GNP) per capita and health expenditure per capita also have strong association with maternal mortality. CONCLUSIONS: The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country. Based on these findings, it is recommended that structural arrangements be made to train skilled health personnel to take care of maternal health problems. In view of the high cost of training physicians, middle-level health personnel may offer an affordable alternative to handle emergency obstetrical cases to address the shortage of physicians. In addition, the allocation of adequate resources to the health sector could improve maternal mortality. The economic wealth of a country and life expectancy at birth are less modifiable through short-term specific interventions. Additionally, it is recommended that country-specific interventions are needed to correct the problem of lack of critical data for analysis.

Adult↗
PubMed2004

Maternal mortality in Italy, 1980-1996.

OBJECTIVE: To establish the extent of maternal mortality in Italy in between 1980 and 1996 in order to compare it with the international data. STUDY DESIGN: We conducted a retrospective study on maternal deaths in Italy from 1980 to 1996. Data have been collected by Italian Statistic Institute (ISTAT). We calculated both the maternal mortality rates and the percentages of causes of death in the whole period, according to WHO definitions. RESULTS: The data confirmed the trends of the previous decade: maternal mortality rates have decreased from 13.25 (1980) to 3.78 (1996) for 100000 live births. Haemorrhage and hypertension have been the main causes of maternal death, while pulmonary embolism has had a minor affect on maternal mortality rates compared to other countries, particularly in Europe. CONCLUSION: Italian data appear reassuring and encourage further investigations on detailed welfare problems.

Abruptio Placentae↗
PubMed2002

Are maternal deaths on the ascent in Singapore? A review of maternal mortality as reflected by coronial casework from 1990 to 1999.

INTRODUCTION: In Singapore, published maternal mortality rates (MMR) over the last decade (1990 to 1999) have been so low (0.0 to 1.0 per 1000 live births and still births) as to imply that maternal deaths are rare to the point of being non-existent in some years. This inference is counterintuitive, and earlier studies on maternal mortality, amniotic fluid embolism (AFE) and pulmonary thromboembolism (PTE) have also suggested otherwise. Accordingly, local trends in maternal mortality warrant further examination. MATERIALS AND METHODS: A descriptive and comparative study, comprising a clinico-pathological review of maternal deaths, for which autopsies were conducted by the Centre for Forensic Medicine, during a 10-year period from 1990 to 1999. The annual necropsy-based, MMR (estimated MMR), as well as the prevalence of maternal deaths during this time, were estimated with the aid of the relevant, published demographic data on live births and still births. These were compared with the corresponding rates calculated (calculated MMR) from raw demographic data on maternal deaths classified as such in the published data. RESULTS: Coronial autopsies were conducted on a total of 51 cases of maternal death, of which 33, 17 and 1 were direct, indirect and fortuitous deaths, respectively. The annual, estimated MMR ranged from 0.4 to 1.8 per 10,000 live births and still births. The estimated MMR was twice as high as the calculated MMR and a statistically significant upward linear trend was demonstrated for the former (P = 0.046). AFE (16/51) and PTE (10/51) were the two most common causes of maternal death; their corresponding cause-specific, 10-year prevalence being 0.33 and 0.21 per 10,000 live births and still births, respectively. There was apparent clustering of the cases of PTE during the earlier part of the last decade (1990 to 1995), corresponding to a statistically significant, upward trend in its overall necropsy incidence during that time (P = 0.019). Cardiovascular and pulmonary disorders constituted the bulk of indirect deaths (13/17), while antenatal suicides accounted for 3 of these deaths (0.06 per 10,000 live births and still births). CONCLUSIONS: This was an upward trend in MMR, as reflected in coronial casework, over the last decade. It would appear that the local, estimated (direct and indirect) maternal mortality prevalence compares favourably with the MMR reported in developed countries. The apparent rate of AFE was no less than 4 times higher than that reported in the United Kingdom, while the maternal mortality rate from PTE was at least as high. Allowing for the possibility that such deaths were under-reported, the actual annual MMR and 10-year prevalence could be appreciably higher than the estimates presented here. There may well be a case for the establishment of a comprehensive database of maternal deaths, that is updated continually and contemporaneously, in Singapore.

Adult↗
PubMed2005

[Analysis of maternal mortality in the Czech Republic in 2001].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 2001. DESIGN: Retrospective statistical and clinical analysis. SETTING: Mother and Child Care Institute, Prague-Podoli. METHODS: We used database of 9 cases of maternal deaths in the Czech Republic during 2001 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total of 9 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 2001. During the same period there were 90,715 live births in the Czech Republic, and Pregnancy-related mortality ratio (A+B+C) was 0.0992/1000, i.e. 9.92 deaths per 100,000 live births. This is about 1.08/1000 better than in 2000 (the table 5 demonstrates the development of maternal mortality during the last 11 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A+B) was 0.0882/1000, i.e. 8.82 deaths per 100,000 live births versus 9.9 deaths per 100,000 live births in 2000. Group A (specific risk-direct maternal mortality) contributed to adjusted maternal mortality by 5 maternal deaths and direct maternal mortality was 5.5 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.

Adult↗
PubMed1999

Pre-eclampsia and the HELLP syndrome still cause maternal mortality in The Netherlands and other developed countries; can we reduce it?

Maternal mortality in developed countries does not seem to have decreased during the past decade, despite good prenatal care. Hypertensive disorders of pregnancy are the main cause of maternal mortality in most countries. In more than half of these cases, the HELLP syndrome is involved. In this article attention is drawn again to the life-threatening complications that might occur in cases of pre- eclampsia and the HELLP syndrome. Two case histories with fatal outcomes are described to provide extra emphasis. The literature indicates that some cases of maternal mortality might be avoidable. From a review of the literature, suggestions and recommendations are made about how to achieve a decrease in maternal mortality from pre-eclampsia/the HELLP syndrome. The most important are the making of an early, correct diagnosis, anticipating the possibilities of serious complications, and, if necessary, early referral to a regional centre with special expertise.

Adult↗
PubMed1989

[Maternal mortality at the Hospital Center of Libreville (1984-1987)].

Maternal mortality at the University Hospital of Libreville was 152.5 for every 100,000 live births. There were 48 maternal deaths out of 31,799 deliveries carried out between 1984 and 1987. The principal causes were: haemorrhage in 45.8%, infections in 20.8%, intercurrent diseases in 20.8%, vasculo-renal syndromes in 10.4% and thromboses in 2%. The main differences between this country and developed countries were the large number of haemorrhages and the rarity of thrombosis. Poor prognostic factors were SS sickle-cell disease in 10.4% of the cases who died and in deaths due to anaemias, of which 25% were due to haemorrhage connected with the afterbirth. Complications occurring in the 1st trimester of pregnancy caused nearly a third of all maternal deaths. Complications of abortion occurred in 16.6% and of extra-uterine pregnancies in 14.6%. If the maternal mortality rate is to be reduced it is important to have a proper blood bank. The risks of caesarean section are ten times greater than of vaginal delivery, although it is a good way out for difficult situations. The indications for the operation have to be carefully considered. Comparing the statistics reported from Cotonou, the University Hospital in Libreville has a lower incidence of maternal mortality but it is too high and requires real progress to be made.

Abortion, Induced↗
PubMed1997

Human development index as a predictor of infant and maternal mortality rates.

OBJECTIVE: The United Nations Human Development Index (HDI) is a composite index of life expectancy, literacy, and per capita gross domestic product that measures the socioeconomic development of a country. We estimated infant and maternal mortality rates in the world and assessed how well the HDI and its individual components predicted infant and maternal mortality rates for individual countries. MATERIALS: Data on mortality rates and values for HDI components were obtained from the United Nations and the World Bank. RESULTS: For the 1987 to 1990 period, approximately 9 million infant deaths and 349,000 maternal deaths occurred in the world annually, yielding global infant and maternal mortality rates of 67 per 1000 and 250 per 100,000 live births, respectively. HDI is a powerful predictor of both infant and maternal mortality rates. It accounts for 85% to 92% of the variation in infant mortality rates, and 82% to 85% of the variation in maternal mortality rates among countries. Each component of HDI is also strongly correlated with both infant and maternal mortality rates (significance of all values for r, p < 0.001), and eliminating life expectancy from HDI does not decrease significantly the predictive power of HDI for infant or maternal mortality rates. CONCLUSION: HDI is not only a useful measure for socioeconomic development, but also a powerful predictor of infant and maternal mortality rates for individual countries.

Adolescent↗
PubMed1994

Trends in maternal mortality at a university hospital in Turkey.

OBJECTIVE: To highlight recent trends in maternal mortality in Hacettepe University Hospital. METHOD: A retrospective clinical analysis of 117 maternal deaths between 1968 and 1992. RESULTS: The overall maternal mortality ratio was 180/100,000 (108/59,993). In terms of 5-year periods, the maternal mortality ratio declined from 417.7 in 1968-72 to 73.7 in 1988-92. Infection was the most common cause of death (59.8%), followed by cardiac disease (8.5%) and hemorrhage (8.5%). Infection related deaths were either due to septic abortion (75.7%) or puerperal sepsis (24.3%). While 73.9% of all deaths were due to infection in 1968-72, this figure contributed only 9.1% of the deaths in 1988-92. When infection, hemorrhage, cardiac disease ad toxemia are investigated together, percentages of their contribution varies from 95.7% in 1968-72 to 54.5% in 1988-92 period. CONCLUSIONS: Maternal mortality ratios are decreasing significantly in our institution. An another promising finding is the further reduction in direct causes especially in recent years. However, an improvement in the care of pregnant women is necessary to continue this declining trend.

Abortion, Septic↗