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PubMed2001

Two years maternal mortality in Matebeleland north Province, Zimbabwe.

OBJECTIVE: To describe timeliness and completeness of maternal mortality notifications after the introduction of a revised national notification form in 1998, as well as socio-demographic and obstetric variables and causes of maternal deaths. DESIGN: Retrospective descriptive study. SETTING: Seven districts in Matebeleland North province. SUBJECTS: 95 maternal death notifications from 1 August 1998 to 31 July 2000. MAIN OUTCOME MEASURES: Delay in submission and completeness of reports, age, marital status, religion, reproductive history, booking and referral status, duration and outcome of pregnancy, place of death, cause of death. RESULTS: 92/95 notifications were true maternal deaths, 86% were notified within 48 hours and 79% were complete, 74% of the deaths took place in a health facility. Mean age of the women was 27.8 years, mean parity 3.0. Sixty percent had booked. The five main causes of death were obstetric haemorrhage (26%), malaria (24%), immune deficiency syndrome (13%), abortion (11%) and eclampsia (8%). The maternal mortality ratio per 100,000 reported home and institutional live births ranged from 155 to 532 per district. CONCLUSION: There is under reporting of maternal mortality in some districts, although from 1997 to 2000 a 200% increase in reporting was seen. Timeliness and completeness of reporting was satisfactory. With the exception of a high contribution from malaria the causes of maternal mortality in Matebeleland North province are similar to those reported elsewhere in Zimbabwe.

Cause of Death↗

PubMed1998

Maternal mortality--United States, 1982-1996.

Maternal and infant mortality are basic health indicators that reflect a nation's health status. In the United States, infant mortality has declined steadily; however, this is not true for maternal mortality. This report presents data from death certificates compiled by CDC's National Center for Health Statistics, which indicate that in the United States, the annual maternal mortality ratio remained approximately 7.5 maternal deaths per 100,000 live births during 1982-1996.

Female↗

PubMedDate not supplied

[Interventions to reduce maternal mortality].

The authors comment a proposal to adopt measures to reduce maternal death and suggest four levels of action: 1) actions aimed at improving the knowledge about the number and factors associated to high risk maternal mortality during pregnancy, delivery and puerperium; they comment on the undernumeration of maternal death cases and propose an improvement in vital statistics, epidemiologic investigation and the creation of maternal mortality committees; 2) action to assist pregnancy, delivery and puerperium, to increase both the coverage and the quality of medical care, prenatal care, institutional care to delivery, and post-partum care; 3) action to prevent pregnancy in women with high risk of maternal mortality, improving diagnosis and treatment of diseases that increase maternal risk, and promoting contraception for these cases; 4) other actions aimed at reducing the risk of death brought about by induced abortion.

Abortion, Spontaneous↗

PubMed1988

Maternal mortality surveillance, United States, 1980-1985.

To better define the incidence, causes, and risk factors associated with maternal deaths, the Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC, coordinated a study by the Maternal Mortality Collaborative, a Special Interest Group of the American College of Obstetricians and Gynecologists (ACOG). In 1983, this group established voluntary surveillance of maternal deaths for the years 1980-1985. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 39% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Overall, women over 30 years of age had a higher risk of dying than did younger women. For each age group, women of black and other races who were 30 years and older having the highest risk. The leading causes of maternal deaths were embolism, hypertension in pregnancy, sequelae from ectopic pregnancy, hemorrhage, cerebrovascular accidents, and anesthesia complications. Of the 111 nonmaternal deaths, 90 (82%) were attributed to unintentional or intentional injuries. As a result of the success of this voluntary reporting system, the Division of Reproductive Health initiated National Pregnancy Mortality Surveillance in January 1988.

Adult↗

PubMed2005

Maternal mortality in resource-poor settings: policy barriers to care.

Maternal mortality remains one of the most daunting public health problems in resource-poor settings, and reductions in maternal mortality have been identified as a prominent component of the United Nations Millennium Development Goals. The World Health Organization estimates that 515000 women die each year from pregnancy-related causes, and almost all of these deaths occur in developing countries. Evidence has shown that access to and utilization of high-quality emergency obstetric care (EmOC) is central to efforts aimed at reducing maternal mortality. We analyzed health care policies that restrict access to life-saving EmOC in most resource-poor settings, focusing on examples from rural India, a country of more than 1 billion people that contributes approximately 20% to 24% of the world's maternal deaths.

Anesthesia, Obstetrical↗

PubMed2003

HIV/AIDS: impact on maternal mortality at the Johannesburg Hospital, South Africa, 1995-2001.

This study investigated maternal mortality at the Johannesburg Hospital, a 1100-bed academic hospital in South Africa. Patient records were assessed retrospectively over two time periods: 1995/1996 and 2000/2001. Causes of death were noted and compared with national data. The two time periods were compared to identify disease patterns and the role of anaesthesia in maternal mortality. The maternal mortality ratios were respectively 183 and 354 per 100000 live births respectively. Hypertension in pregnancy was the leading cause of mortality in 1995/1996, accounting for 10 out of the 20 deaths, but was the second most common cause in 2000/2001 (6 out of 35). HIV/AIDS-associated disease was the leading cause of mortality in 2000/2001 (42.7%, increasing from 20% in 1995/1996) with pneumonia the commonest cause of death. The statistics at this hospital were consistent with the national trend of an increasing association with HIV/AIDS. No deaths were found to be directly attributable to anaesthesia in either of the time periods. There is a need for clearer documentation of HIV status in pregnancy and antiretroviral intervention strategies must be considered.

Journal Article↗

PubMed2002

[Maternal mortality. A challenge of the new millennium].

Maternal mortality is a principal concern of the contemporary society because of consequence to generate since the most cases to be about young woman and healthy, whose death be able to avoid. This study analyzed the cases registered in Aguascalientes delegation of IMSS during ten years with purpose to find strategy for to salve. The case fatality rate was average of 26.1 x 100,000 alive births. The principal causes was the obstetric hemorrhages; preeclampsia and lung thrombosis. The greater percentage was in woman aged between 25-39 years and multiparous. Most of 50% doing appropriate prenatal control. A greater percentage was pregnancy of term with 77.4 a live births and 59% performed cesarean sections. 93% was through the puerperium. Only 20% was to classify as treatment inappropriate and inopportune and 74% was maternal mortality foreseeable. Some type responsibility existed in 38.7%.

Adult↗

PubMed2002

The maternal mortality review meeting: experiences from Kalabo District Hospital, Zambia.

We report on our experiences with a maternal mortality review meeting in Kalabo District Hospital between 1999 and 2001. Patient files and minutes of the maternal mortality review meetings of 15 cases of maternal death were reviewed. Causes of death, classification, substandard care factors, recommendations and implementation were analysed. In nine cases of maternal death 20 different substandard care factors were found; 12 caused by organizational weaknesses, eight by substandard clinical care. In nine cases, recommendations were formulated, which were completely implemented in five and partially implemented in two cases. A maternal mortality review meeting can be an important tool for improving essential obstetric services in a district hospital. It can easily and directly correct some substandard care factors, has a high educational value for staff and leads to a better understanding of maternal mortality for everyone involved.

Adolescent↗

PubMed2002

Maternal mortality in Herat Province, Afghanistan, in 2002: an indicator of women's human rights.

CONTEXT: Maternal mortality rates in Afghanistan are estimated to be high. OBJECTIVE: To assess maternal mortality and human rights issues in Herat, Afghanistan. DESIGN AND SETTING: Cross-sectional survey of 4886 Afghan women living in 7 districts in Afghanistan's Herat Province, which included 34 urban and rural villages/towns. Using structured interviews/questionnaires, these women also provided maternal mortality information on 14 085 sisters in March 2002. A survey of health facilities in the 7 districts was also conducted. PARTICIPANTS: Mean (SE) age of the respondents was 31 (0.23) years (range, 15-49 years). The majority had received 0.35 (0.11) years of formal education and 4233 (88%) were married (mean [SE] age at marriage, 15 [0.3] years; range, 5-39 years). The mean (SE) number of pregnancies was 5.0 (0.08) and live births was 4.6 (0.2). RESULTS: There were 276 maternal deaths among 14 085 sisters of the survey respondents (593 maternal deaths/100 000 live births per year; 95% confidence interval [CI], 557-630). Of the 276 deaths, 254 (92%) were reported from rural areas. The respondents reported the following primary problems: lack of food (41%), shelter (18%), and clean water (14%). Of 4721 respondents, 4008 (85%) wanted to get married at the time of their wedding, but 957 (20%) felt family pressure. Of 4703 women, 4117 (87%) had to obtain permission from their husband or male relative to seek health care; only 1% (54/3946) reported not being permitted to obtain prenatal care. Of 4881 women, 597 (12%) used birth control, but 23% (1013/4294) wanted to use birth control. Of 4306 women, 3189 (74%) reported that decisions about the number and spacing of children were made by husband and wife equally. Of 4637 respondents, 519 (11%) reported receiving prenatal care. Of 4624 women, 40 (0.9%) reported a trained health care worker was present at birth; 97% (4475/4612) had untrained traditional birth attendants. Only 17 of 27 listed health facilities were functional and only 5 provided essential obstetric care. Only 35 physicians served a population of 793 214. CONCLUSIONS: Women in most of Herat Province, Afghanistan, have a high risk of maternal mortality. Human rights factors may contribute to preventable maternal deaths in the region.

Adolescent↗

PubMed1991

Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986.

This report presents results of a descriptive study to estimate the mortality rate, identify the type and the causes of maternal deaths. The study was conducted in 1987 in Kampala hospitals for a period covering seven years from 1st January 1980 to 31st December, 1986. The non abortion maternal mortality rate (NAMMR) was 2.65 per 1000 deliveries while the abortion related maternal mortality rate (ARMMR) was 3.58 per 1000 abortions. There was a statistically significant increase in NAMMR while the increase in ARMMR was almost significant over the seven year period. Of all maternal deaths, 80 per cent were non abortion while 20 per cent were abortion related. The commonest immediate causes of death, in order of importance, were sepsis, haemorrhage, ruptured uterus, anaesthesia and anaemia. The commonest patient management factors which contributed to death, in order of importance, were lack of blood for transfusion, lack of drugs and intravenous fluids, theatre problems and doctor related factors. We feel that a lot happens to the pregnant mother before she finally reaches a health unit for delivery and that there is a great need to improve on the community's gynaecological and obstetrical services as well as ambulance and emergency services. We also feel that maternal mortality in developing countries could be reduced if the health workers were imaginative in respect to each patient, tried not to operate as though they were working in a developed country, and created relevant solutions for the local problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

PubMed1996

Maternal mortality in a Kenyan pastoralist population.

OBJECTIVE: To measure maternal mortality among the Gabbra, a group of nomadic pastoralists living in a remote area of Kenya. METHOD: As part of a survey of 851 households, information on the number of sisters of respondents who died of pregnancy-related causes was collected and the data were used to calculate maternal mortality statistics using the sisterhood (an indirect) method. RESULTS: The maternal mortality ratio for this population was 599 deaths per 100,000 births (95% C.I. 424-775). The lifetime risk of dying around childbirth is 1 in 30, and the proportion of ever-married sisters that died under 50 years of age who died from maternal causes is 0.48 (95% C.I. 0.38-0.58). CONCLUSION: The risk of dying of maternal causes is high in this population.

Adolescent↗

PubMed2006

[Maternal mortality among black women in Brazil].

Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown), thus representing a major expression of social inequality. The article concludes with a review of political and technical recommendations to decrease maternal mortality.

Black People↗

PubMed1999

A study of maternal mortality at the University Teaching Hospital, Lusaka, Zambia: the emergence of tuberculosis as a major non-obstetric cause of maternal death.

SETTING: The Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia. OBJECTIVES: To ascertain 1) the non-obstetric causes of maternal mortality, 2) the importance of tuberculosis as a cause of maternal deaths, and 3) the trends in the aetiology of non-obstetric causes of maternal deaths during the past decade in the light of the human immunodeficiency virus epidemic. DESIGN: A 2-year retrospective study of the aetiology of all maternal deaths occurring at the University Teaching Hospital (UTH), Lusaka, Zambia between 1 January 1996 and 31 December 1997. Comparison of these data with available data published between 1974 and 1989. RESULTS: There were 251 maternal deaths recorded during the study period. Of these, 106 (42%) were due to direct (obstetric) causes and 145 (58%) were due to indirect (non-obstetric) causes. Malaria (30%), tuberculosis (25%) and unspecified chronic respiratory tract infections (22%) accounted for 77% of non-obstetric causes of maternal deaths and 44% of all causes of maternal deaths. The diagnosis of AIDS was closely linked with that of tuberculosis (92% of cases), and unspecified chronic respiratory illnesses (97%), but not with malaria (37%). The maternal mortality ratio for UTH was calculated at 921 per 100,000 live births, a significant increase from the 118 noted in 1982 and 667 in 1989. CONCLUSIONS: Despite improved obstetric services, the maternal mortality ratios at UTH, Lusaka, have increased eight-fold over the past two decades. This dramatic increase is mainly due to non-obstetric causes of death. Malaria and AIDS-associated tuberculosis and unspecified 'chronic respiratory illnesses' are now major causes of maternal death in Zambia. Greater emphasis is urgently required on early detection, accurate diagnosis, treatment and prevention of malaria and tuberculosis in pregnancy. Further definition of chronic 'unspecified' respiratory illnesses is also required.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Maternal mortality in the city of Rio de Janeiro, 1993-1996].

The maternal mortality rate is considered an important indicator of quality of care during the gravid-puerperal cycle. To shed light on the maternal mortality pattern in the city of Rio de Janeiro, maternal deaths from 1993 to 1996 among residents of the city were analyzed, based on data from death certificates. The maternal mortality rate was calculated according to cause, age, and schooling. High annual mortality rates were detected throughout the period analyzed (74.3, 47.9, 51.5, and 55.3 per 100,000 live births, respectively). Main causes of death were hypertension, hemorrhage, and puerperal complications. Greatest risk of death was among the youngest and oldest women and those with less schooling. The study discusses strategies to decrease under-recording of deaths and increase quality and results of care.

Adolescent↗

PubMedDate not supplied

Maternal mortality in India: estimates from a regression model.

This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India.

Adolescent↗

PubMed1988

Maternal mortality in Bahrain with special reference to sickle cell disease.

The maternal mortality in Bahrain during the 10-year period, 1977-1986, was 33.9 per 100,000 livebirths; the second 5-year period showed a significant reduction (26.9) compared to the first 5-year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.

Anemia, Sickle Cell↗

PubMed1994

Institutional maternal mortality in Mali.

OBJECTIVES: To measure the institutional maternal mortality ratio (MMR) in Mali and suggest ways to reduce it. METHODS: Routinely recorded data from 24 health institutions in three regions were reviewed for 1988 to 1992. RESULTS: The overall MMR in the institutions was 201 maternal deaths per 100,000 live births. Hemorrhage, toxemia and infections accounted for 80% of the 360 recorded maternal deaths, almost all of which were preventable. The main reasons why these conditions result in death lie in poor quality and maldistribution of health services, lack of transport and late use of allopathic services. CONCLUSIONS: Maternal mortality is still a major public health problem in Mali, even among the small proportion of women who reach health facilities. Substantial new initiatives are urgently needed to reduce this major cause of preventable adult female mortality.

Adolescent↗

PubMed1994

Maternal mortality and related factors in Ejisu District, Ghana.

A community-based survey on maternal mortality was carried out in the Ejisu health district of Ghana in January and February 1990 to identify all women who died in pregnancy, delivery or the puerperium from January 1985 to December 1989, determine their characteristics, the presumptive causes of death and related factors. Forty-four women who died in pregnancy, delivery or the puerperium were identified over the stated period. 59% were aged between 20 and 34 years. Eighty-two percent were married and sixty-six percent had at least primary education. Based on an average crude birth rate of 40 per 1000 population for the district over the period, the lowest maternal mortality rate occurred in 1988, 120 per 100,000 total births and the highest occurred a year later, 235 per 100,000 total births. The main presumptive causes of maternal mortality in the district were postpartum haemorrhage 45.5%, jaundice in pregnancy 22.7%, obstructed labour 6.8%, eclampsia 6.8% and fever 4.6%. 59% of them died in a hospital, 2% died at a Government Maternity Home and 7% died during referral from health facilities in the district. Thirty-four percent of the women who died did not attend any antenatal clinic. The actual number of deaths may be underestimated due to the sampling method used and the difficulties encountered in linking survey data with hospital records. Based on the survey findings and other related PMM research, plans have been developed to reduce maternal mortality in the district as outline in the conclusion.

Adult↗