SEARCH · PubMed Health

Results for “MATERNAL MORTALITY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources

PubMed2004

The decline in maternal mortality in Sweden: the role of community midwifery.

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.

Community Health Nursing↗

PubMed2005

Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity.

BACKGROUND: Audit and feedback of critical incidents is an established part of obstetric practice. However, the effect on perinatal and maternal mortality is unclear. The potential harmful effects and costs are unknown. OBJECTIVES: Is critical incident audit and feedback effective in reducing the perinatal mortality rate, the maternal mortality ratio, and severe neonatal and maternal morbidity? SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2005), the Cochrane Effective Practice and Organisation of Care Group Trials Register (January 2005), MEDLINE (1965 to December 2004), EMBASE (1965 to December 2004), SCIBASE (1965 to December 2004) and the World Health Organization systematic review of maternal mortality and morbidity database (January 1997 to December 2002). SELECTION CRITERIA: Randomized trials of audit (defined as any summary of clinical performance over a specified period of time) and feedback (method of feeding that information back to the clinicians) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. DATA COLLECTION AND ANALYSIS: No suitable trials were found. MAIN RESULTS: None. AUTHORS' CONCLUSIONS: The necessity of recording the number and cause of deaths is not in question. Mortality rates are essential in identifying problems within the healthcare system. Maternal and perinatal death reviews should continue to be held, until further information is available. The evidence from serial data clearly suggests more benefit than harm. Feedback is essential in any audit system. The most effective mechanisms for this are unknown, but it must be directed at the relevant people.

Cause of Death↗

PubMed2003

Maternal mortality and access to obstetric services in West Africa.

OBJECTIVES: Process evaluation has become the mainstay of safe motherhood evaluation in developing countries, yet the extent to which indicators measuring access to obstetric services at the population level reflect levels of maternal mortality is uncertain. In this study we examine the association between population indicators of access to obstetric care and levels of maternal mortality in urban and rural West Africa. METHODS: In this ecological study we used data on maternal mortality and access to obstetric services from two population-based studies conducted in 16 sites in eight West African countries: the Maternal Mortality and Obstetric Care in West Africa (MAMOCWA) study in rural Sénégal, Guinea-Bissau and The Gambia and the Morbidité Maternelle en Afrique de l'Ouest (MOMA) study in urban Burkina Faso, Côte d'Ivoire, Mali, Mauritanie, Niger and Sénégal. RESULTS: In rural areas, maternal mortality, excluding early pregnancy deaths, was 601 per 100,000 live births, compared with 241 per 100,000 for urban areas [RR = 2.49 (CI 1.77-3.59)]. In urban areas, the vast majority of births took place in a health facility (83%) or with a skilled provider (69%), while 80% of the rural women gave birth at home without any skilled care. There was a relatively close link between levels of maternal mortality and the percentage of births with a skilled attendant (r = -0.65), in hospital (r = -0.54) or with a Caesarean section (r = -0.59), with marked clustering in urban and rural areas. Within urban or rural areas, none of the process indicators were associated with maternal mortality. CONCLUSION: Despite the limitations of this ecological study, there can be little doubt that the huge rural-urban differences in maternal mortality are due, at least in part, to differential access to high quality maternity care. Whether any of the indicators examined here will by themselves be good enough as a proxy for maternal mortality is doubtful however, as more than half of the variation in mortality remained unexplained by any one of them.

Africa, Western↗

PubMed1979

Cohort maternal mortality: New York, 1917-1972.

Data on New York State maternal mortality, 1917-1972, are analyzed and show that the cohort patterns of age-specific maternal mortality are mainly a reflection of the pattern of period declines in age-specific maternal mortality.

Adolescent↗

PubMed2003

Trends in maternal mortality: a 13-year hospital-based study in rural Ghana.

OBJECTIVE: To measure the impact of the Safe Motherhood Initiative (SMI) on hospital-based maternal mortality since its start in 1987. STUDY DESIGN: Retrospective analysis of all 229 maternal deaths in a district hospital in rural Ghana, between 1 January 1987 and 1 January 2000. Main outcome measures were maternal mortality ratio and relative contribution of causes of maternal deaths to overall maternal mortality. Chi-square test was used to assess differences in proportions, and relative risks with confidence intervals were calculated. RESULTS: The overall maternal mortality ratio of 1077/100,000 live births did not change significantly during the study period. However, the relative contributions of sepsis, hemorrhage, obstructed labor, anemia/sickle cell disease and (pre-) eclampsia diminished, while abortion complications increased significantly. CONCLUSIONS: The Safe Motherhood Initiative in the study area has contributed to the reduction of maternal mortality due to causes against which interventions were directed. Abortion complications as cause of maternal mortality need to be included in interventions and research.

Abortion, Induced↗

PubMed2005

Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratios.

OBJECTIVE: Our study's objective was to determine the relationship between state-specific maternal mortality ratios and the density of maternal-fetal medicine specialists. STUDY DESIGN: State maternal mortality ratios from 1994 to 2001 were calculated from the Centers for Disease Control and Prevention WONDER database. Practitioner distribution data were obtained from professional associations. Demographic information regarding states was gathered from the 2000 US census data. Bivariable and multivariable analyses were conducted with the use of Spearman correlations and Poisson regression, respectively. RESULTS: The median state maternal-mortality ratio was 7.5/100,000 live births. Our study showed that an increase of 5 maternal-fetal specialists per 10,000 live births results in a 27% reduction in the risk of maternal death (relative risk [RR] = 0.73, 95% CI = 0.58-0.93, P = 0.012). This risk reduction was based on a multivariable Poisson regression model that included the following variables and their significant interactions: state-specific percentages of mothers in poverty, mothers without a high school diploma, minority mothers, and teenage mothers. CONCLUSION: The density of maternal-fetal medicine specialists is significantly and inversely associated with maternal mortality ratios, even after controlling for state-level measures of maternal poverty, education, race, age, and their significant interactions.

Adult↗

PubMed2001

Adolescent maternal mortality in Mozambique.

PURPOSE: To describe adolescent maternal mortality and analyze its avoidability. METHODS: An audit approach was used to clarify the presence of avoidable factors in 239 maternal deaths, of which 22% were among adolescents. RESULTS: The main causes of adolescent death were malaria, pregnancy-induced hypertension, puerperal sepsis, and septic abortion. The audit classified as avoidable 75% of all maternal deaths. CONCLUSION: Adequate strategies addressing the special needs of adolescents are required to prevent currently high levels of maternal mortality in this age group.

Adolescent↗

PubMed1997

Direct and indirect estimates of maternal mortality in rural Burkina Faso.

A retrospective study of maternal mortality was conducted in Nouna, a rural area of Burkina Faso in 1992. Strong evidence was found of a major mortality decline among children and young adults over the 50 years preceding the study: The estimated life expectancy of 36 years in around 1945 rose to 58 years in 1991. Direct and indirect (using the sisterhood method) estimates of the maternal mortality ratio (MMR) were compared. Overall, the direct estimate of the MMR (389 deaths per 100,000 live births) for women aged 15 and older was slightly lower than the indirect estimate (428 deaths per 100,000). Taking into account the biases involved in the use of information obtained from sisters, the direct estimates indicated a marked decline in maternal mortality over time from 569 deaths per 100,000 around 1941 to 305 deaths around 1987. The validity of both data and approach, as well as the discrepancies between the direct and indirect methods, are discussed.

Adolescent↗

PubMed2006

Maternal mortality among Palestinian women in the West Bank.

OBJECTIVE: To assess maternal mortality and determine the most common causes of maternal death among Palestinian women. METHODS: Available data on the 431 women who died between the ages of 15 and 49 years in the West Bank in 2000 and 2001 were reviewed. The data were collected from official agencies and, using the verbal autopsy approach, interviews of the deceased women's relatives. The interviews were conducted in all 10 districts of the West Bank over 30 months. RESULTS: Maternal mortality ratios for 2000 and 2001 were 29.2 and 36.5 per 100,000 live births, respectively. Cardiovascular diseases and hemorrhage were the most common causes of death. Misclassification was found in 38% of the deaths. A tentative analysis of avoidability indicated that 69% of maternal deaths could be classified as avoidable. CONCLUSION: A majority of the maternal deaths identified were avoidable. Substandard classification of maternal deaths is hampering efforts to reduce maternal mortality.

Adolescent↗

PubMed2000

Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death.

BACKGROUND: The high maternal mortality levels in today's developing countries were also found throughout the history of currently affluent countries. The parish information system in Sweden offers unique possibilities for research in historical cohorts. Furthermore, vital events surveillance systems are scarce in today's developing countries. METHODS: This cohort study covers 42,387 mothers who gave birth to 150,932 infants during the 19th century in the Skellefteå and Sundsvall areas. Among these women, 1,237 were dead within one year after delivery. The analysis of the cause of these deaths was done according to the various ICD definitions. Parity five and above was defined as grand multiparity. RESULTS: Maternal mortality ratios, deaths per 100,000 live births were as follows: 256.4 (direct obstetric deaths), 320.7 (direct and indirect obstetric deaths), 489.2 (pregnancy-related deaths), 347.8 (late maternal deaths) and 837.0 (maternal deaths and late maternal deaths). In this study, 59% of all maternal deaths occur within the first 42 days of delivery, two thirds of them having direct and indirect obstetric causes. Of the late maternal deaths, the bulk were infectious or other indirect deaths, mirroring more general female mortality and the pre-existent endemic situation of tuberculosis and other infectious diseases. The combination of previous stillbirth and infant death represented the highest risk ratios, RR 2.77-3.62, while grand multiparity was not associated with increased risk. Urbanized and industrialized areas tended to have higher maternal mortality. CONCLUSIONS: In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Cause of Death↗

PubMed1989

Maternal mortality in Hong Kong 1961-1985.

The maternal mortality rate in Hong Kong fell from 0.45/1000 total births in 1961 to 0.05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2,193,012 births. Of the 438 deaths 150 (34%) were due to haemorrhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre-eclampsia (ICD 642, 643) and 60 (13.7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961-1965 and 1981-1985 showed an 86% reduction in deaths due to haemorrhage and pre-eclampsia and a 72% reduction in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.

Adult↗

PubMedDate not supplied

A ten year review of maternal mortality in Sokoto, northern Nigeria.

OBJECTIVE: To determine the institutional maternal mortality ratio, risk factors, causes and to suggest ways of preventing or reducing the maternal deaths. SUBJECTS & METHODS: A descriptive study based on hospital case records of all maternal deaths at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, between January 1990 and December 1999. RESULTS: There were 197 maternal deaths and 9,158 live births during the study period. The maternal mortality ratio was 2,151/100,000 live births. Mean age at death was 27 years. Risk factors included nulliparity, poverty; illiteracy and lack of prenatal care. Main causes of death were ruptured uterus, eclampsia, infection and haemorrhage. CONCLUSION: The maternal mortality ratio is high. Most of the deaths could have been prevented by prenatal care and prompt treatment of the obstetric emergencies. Unless somebody, somewhere, is prepared to cater for the poor at times of dire need, the maternal death toll will remain high.

Adolescent↗

PubMed1977

Maternal mortality in Michigan: an epidemiologic analysis, 1950-1971.

An analysis was performed of direct maternal mortality over 22 years (1950 through 1971) in the state of Michigan. The overall direct maternal mortality rate fell from 5.0/10,000 live births in 1950 to 1.5 in 1971. The rate among nonwhites was more than four times greater than among whites and the difference in relative risk did not narrow over the 22 years. Mortality rates increased with increasing maternal age but not with increasing parity. Nulliparous women had a significantly higher mortality rate than did parous women, particularly those over 25 years of age. when the white gravida of urban Wayne County were compared with the white gravida of 33 rural counties, no difference in direct maternal mortality rates could be attributed to rurality per se. Hemorrhage, infection, and toxemia were the leading causes of direct maternal death. The data suggest that hospitals with less active obstetrical services were associated with a higher risk of direct maternal mortality than were hospitals whose obstetrical services were more active. An increasing proportion of the direct maternal deaths was designated as preventable over the study period. It is believed that analyses of maternal mortality have led to improved perinatal and obstetrical care and that further advances require their continued support. (Am. J. Public Health 67:821-829, 1977)

Abortion, Spontaneous↗

PubMedDate not supplied

Maternal mortality related to induced abortion in North Carolina: a historical study.

A study of trends in maternal mortality from 1963 to 1992 in North Carolina shows that during the period 1973-1977, when legal abortion first became available, the maternal mortality ratio (maternal deaths per 100,000 live births) for deaths related to induced abortion was almost 85% lower than the ratio during the previous five-year period. The decrease in abortion-related mortality had a substantial impact on the overall maternal mortality ratio during this period, accounting for about 46% of the total decline in maternal deaths. After 1977, the maternal mortality ratio for induced abortion declined to less than one death per 100,000 live births, while the mortality ratio for all other obstetric causes leveled off at about 10 deaths per 100,000 live births.

Abortion, Legal↗

PubMed1986

Maternal mortality in Jamaica.

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10 000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive diseases of pregnancy (26%), haemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.

Adolescent↗

PubMed1985

Maternal mortality and morbidity in cesarean section.

The maternal mortality rate after cesarean section is currently very low, but cesarean section is more hazardous than vaginal delivery by a factor of 2-11. Maternal mortality rates of 0 in large series of cesareans have been achieved in some settings, and this suggests that careful attention to good surgical technique and postoperative care could lower mortality after cesarean even further. Infection is the most common cause of morbidity after cesarean, transfusion being second. A large number of factors modify the risk of infection, the most important being prophylactic antibiotics. There is weak evidence that women are slightly more depressed after cesarean than after vaginal delivery. On average, cesarean sections cost more than vaginal deliveries.

Cesarean Section↗

PubMed2004

Abortion-related maternal mortality in the Russian Federation.

This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.

Abortion, Induced↗

PubMed1993

Maternal mortality in rural communities of Illubabor, southwestern Ethiopia: as estimated by the "sisterhood method".

In this study, the "sisterhood method", a new indirect technique, utilizing a cross-sectional survey by retrospective recall for deriving population-based estimates of maternal mortality for rural communities, was used in rural Illubabor region, Southwestern Ethiopia, in December 1991. The findings indicate a lifetime risk of maternal mortality of 0.0426, or 1 in 23 women; approximating a maternal mortality ratio of 570 per 100,000 live-births. The communities experience high maternal mortality which is compounded by high fertility as reflected by the total fertility rate of 7.6. The method can readily be applied to our settings to estimate the lifetime risk of maternal mortality and derive the maternal mortality ratio. In order to generate awareness, support planning and intervention strategies, community-based estimates of maternal mortality will remain a priority where vital events registration is non-existent and health service statistics are not reliable.

Adolescent↗