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PubMed1999

[Analysis of national maternal mortality rate surveillance. Maternal Death Investigation Cooperative Group of China].

OBJECTIVE: To analyze the results of maternal mortality rate (MMR) surveillance in 247 monitoring areas. METHODS: Based on the demographic characteristics of different areas, stratum sampling method was used, and 247 monitoring points from 30 provinces, autonomous regions and cities covered about 100 million population were selected in China in 1989-1995. RESULTS: In the 7 years of monitoring there were 8,709,220 cases of live births with 5,984 cases of maternal deaths in these monitoring points. The average MMR was 77.4/100,000 with 45.5/100,000 in urban areas and 95.4/100,000 in rural areas. There were significant differences of MMR from area to area from 26.0/100,000 to 308.0/100,000. The causes of maternal deaths in succession were obstetric hemorrhage, pregnancy induced hypertension, heart diseases, amniotic fluid embolism, puerperal infection and hepatic diseases, and these 6 causes constituted 81.6% of the total. According to the audit of mortality cases demanded by WHO, the results showed that there was 73.0% avoidable deaths and 27.0% unavoidable deaths. The main problems were: 49.7% among the medical and health care system, chiefly lack of knowledge and skill of the medical personnels; 44.5% of the pregnant women and their family members lack the basic health knowledge. CONCLUSION: To improve the living condition of both mother and children, to increase hospital delivery rate, training medical personnel's skill, to provide better maternal health care, and to strengthen health education are effective measures to decrease MMR.

Cause of Death↗

PubMedDate not supplied

[Reflections on the measurement of maternal mortality].

The maternal mortality rate is a highly sensitive indicator for the health level of both women and the general population in a given geographical area. There is extensive variability among different countries, and rates are high in underdeveloped or developing areas, as in Brazil. Health authorities from various countries have launched programs aimed at reducing maternal deaths and have thus needed to estimate the actual rates to allow for a proper assessment and to control the programs' progress. However, there are many obstacles and difficulties in obtaining the real values of these measures, mainly because of incomplete data. The aim of this paper is to present some of the proposed methodologies for estimating maternal mortality rates and to call attention to the limits and biases of these methods. Based on the Brazilian case, the article also recommends an improvement in the quality and coverage of the Civil Registry, the official source of data on births and deaths.

Brazil↗

PubMed1982

Maternal mortality. A review of maternal deaths over twenty years at the National Maternity Hospital, Dublin.

A retrospective study of the causes of maternal mortality over the past 20 years in the National Maternity Hospital, Dublin, was undertaken. Anaesthesia contributed to 4.4% of all maternal deaths and to 5.7% of 'true' maternal deaths. In the last 10 years studied it did not contribute to maternal mortality. It was concluded that anesthesia was not a major cause of maternal mortality in this hospital.

Adult↗

PubMed2005

A 50-year audit of maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953-2002).

OBJECTIVE: To audit trends in maternal mortality in the Peninsula Maternal and Neonatal Service (PMNS) over a 50-year period, with respect to rates and patterns of causation. DESIGN: Retrospective and prospective audit. SETTING: The PMNS, an integrated perinatal service composed of primary, secondary and tertiary facilities in Cape Town. Population All women giving birth in the area of the Cape Peninsula served by the PMNS over the 50-year period. METHODS: Data on maternal deaths were collected for 1953-2002 inclusive, from annual obstetric and gynaecological reports. Three triennia (1954-1956, 1981-1983 and 1999-2001) were selected for a detailed comparison of trends in rates and causes of death. MAIN OUTCOME MEASURES: Maternal mortality rates (MMRs). Causes of maternal deaths. RESULTS: Total deliveries increased from 7315 in 1953 to 27,575 in 2002. The MMR declined from 301 deaths per 100,000 deliveries in 1953 to 31.2 in the triennium, 1987-1989. From 1999, the MMR increased, reaching 112 in 2002. Comparing 1954-1956 (MMR of 253.9) with 1981-1983 (MMR of 43.8), there was a marked decline in the MMR related to hypertension (80.4 to 11.3), haemorrhage (50.8 to 4.2), abortion (55 to 4.2), suspected pulmonary embolism (25.4 to 2.8), pregnancy-related sepsis (8.5 to 4.2) and cardiac disease (21.2 to 2.8). Comparing 1981-1983 (MMR of 43.8) with 1999-2001 (MMR of 59.4), there was a decline in the MMR associated with abortion (4.2 to 0). The MMR for haemorrhage, suspected pulmonary embolism and cardiac disease remained the same. There was a slight increase in the MMR attributed to hypertension (11.3 to 14.5) and pregnancy-related sepsis (4.2 to 7.3). There was a marked increase in the MMR associated with non-pregnancy-related infections/AIDS (4.2 to 18.2). CONCLUSIONS: The MMR for all causes of maternal death declined significantly from 1953 to 1981 as a result of several interventions. From 1999, there has been a non-significant increase in MMR, predominantly due to the burden of HIV/AIDS-related mortality.

Cause of Death↗

PubMed1990

Maternal mortality in a maternal-fetal medicine intensive care unit.

Maternal mortality in a large, tertiary-care, intensive care, referral center was reviewed for a six-year period. The first three years of the review were prior to the institution of a maternal-fetal medicine intensive care unit, located in the labor-and-delivery suite. The subsequent three years encompassed a period during which an intensive care unit staffed by maternal-fetal medicine specialists and obstetric anesthesiologists was established in the labor-and-delivery suite. The maternal mortality rate was 21.7/100,000, or 10 maternal deaths in 45,984 deliveries, prior to establishment of the unit and 22.1/100,000, or 11 maternal deaths in 49,700 deliveries, after establishment of the unit. The major causes of maternal mortality were pregnancy-induced hypertension, hemorrhage and infection. It appears that a multi-disciplinary team composed of maternal-fetal medicine specialists and obstetric anesthesiologists can provide the same level of care for critically ill obstetric patients that traditionally would be provided by medical intensive care specialists.

Adolescent↗

PubMedDate not supplied

[Maternal mortality in the Huichol area of Jalisco state, Mexico. The Study Group on Maternal Mortality].

With the aim of estimating the level of maternal mortality, a field survey in 349 Huichol families was carried out from August 1990 to August 1991, using an ad-hoc questionnaire. In 208 deliveries, five maternal deaths were recorded, rendering a maternal mortality rate of 2,403.8 per 100,000 live births. This is a considerably higher rate than those reported at the state and national levels, as well as in other municipalities of the region. All five deaths were due to direct maternal causes and took place during the puerperium. None of the patients received medical care. The high maternal mortality rate observed among Huichol groups can be explained by their disadvantageous social conditions, their lack of access to health care, and also their cultural patterns which, in turn, determine their reproductive behaviour. All these elements place Huichol groups among the worst served populations in Mexico.

Adolescent↗

PubMed1977

The impact of state maternal mortality study committees on maternal deaths in the United States.

State maternal mortality study committees have been widely credited with playing a prominent role in reducing maternal death rates in the United States. To evaluate this hypothesis, we compared the rates of decline in maternal mortality ratios by decades from 1938-40 to 1968-70 for states with such committees to those without. Ratios were calculated from published vital statistics of the United States, and committee initiation dates were obtained from a previous survey. States with committees and those without had nearly equal declines during the first decade; however, states with committees had smaller declines during the latter two decades. Although these committees may have been an important factor in the decline in maternal mortality in the United States, vital statistics data do not document larger declines for states with committees.

Female↗

PubMed1957