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PubMed1990

[A statistical study of the countermeasures to reduce the maternal mortality based on the relationship between the maternal mortality rate and perinatal mortality rate].

Although both the Japanese maternal mortality rate (MMR) and the perinatal mortality rate (PMR) have decreased remarkably in recent decades, the former is still high compared with other advanced countries. A statistical analysis on the relationship between the MMR and the PMR was performed to investigate this discrepancy. During the period of study, both rates fell by over 50 percent. There were definite statistical differences among the PMR for each prefecture but almost none among the MMR. The prefectures with high PMR remained generally high in the PMR and the prefectures with low PMR also remained low in the MMR. There was no significant correlation between the PMR and the MMR. Both maternal and perinatal deaths due to common causes decreased in number, and there were few regional differences concerning effective measures against them. The leading causes of maternal death which are irrelevant to perinatal death are emboli, bleeding, and some other rare medical complications. Emphasis should therefore be laid upon the early diagnosis and treatment of amniotic fluid embolism apart from measures against haemorrhage. Countermeasures for rare complications are also of great importance.

Embolism, Amniotic Fluid↗
PubMed1983

An autopsy study of 306 cases of maternal death in Japan.

Based on autopsy findings in 306 cases of maternal death from 1964 to 1980, recent trends in maternal death in Japan were discussed. Main topics dealt with were as follows: 1. Although rate of maternal death in Japan is decreasing markedly year by year, approximately 90 per cent of our autopsy cases were direct or indirect maternal deaths. 2. The most common category of the direct maternal death was hemorrhage. Unexpectedly uterine rupture was thought to be a common etiological factor for that. 3. One of the most valuable impression obtained in this study was a high percentage of "sudden death". In our series, 85 of 306 cases (27.8 per cent) were of maternal deaths within 6 hours after their general condition began to deteriorate. The first cause of sudden death was hemorrhage, and the second and the third were ectopic pregnancy and amniotic fluid embolism respectively. 4. Although it was very difficult, 16 cases (5.2 per cent) were judged as the maternal death possibly related to drugs. The most widely suspected and used drugs were hysterotonica such as prostaglandin, oxytocin and Deliverin. In these 16 cases of maternal deaths possibly related to drugs either directly or indirectly, amniotic fluid embolism (in 6 cases), uterine rupture (in 3 cases), and cervical laceration (in 2 cases) were confirmed at autopsy and diagnosed as the direct cause of death. However, in the remaining 5 cases, no acceptable findings could be obtained and an exact cause of death had remained unsolved. 5. Fifteen cases (4.9 per cent) of amniotic fluid embolism were confirmed by autopsy. However, only in 6 out of 15 cases, a clinical diagnosis of amniotic fluid embolism was given. In the remaining 9 cases, clinical diagnoses such as "shock of unknown etiology", "septic or endotoxin shock" and "postpartum collapse" were presumed.

Death, Sudden↗
PubMed1980

[Acquired disorders of coagulation among patients at a centralised obstetric unit (author's transl)].

Treatment was given for 34 757 childbirths and 5,317 abortions at the Gynaecological Hospital of Medizinische Akademie Erfurt, GDR, between 1967 and 1977. Disorders of coagulation were recorded from 0.207 per cent of all cases. These had been caused by premature placental detachment, amnion infection, dead foetus syndrome, amniotic fluid embolism, septic abortion, and missed abortion. Incidence, mortality, and therapeutic policies are discussed.

Abortion, Missed↗
PubMed1994

[Analysis of 39 cases of maternal deaths caused by incorrect use of oxytocin].

Thirty-nine cases of maternal deaths directly caused by incorrect use of oxytocin in Fujian Province from 1986 to 1992 were analysed. The results showed that 90.00% of these deaths occurred in the rural and mountainous areas. The main reason was the ignorance of the birth attendents on the pros and cons of oxytocin administration and therefore the incorrect use. The causes of maternal deaths were ranged in the following order: uterine rupture, soft tissue injury of the birth canal and amniotic fluid embolism. All were emergent deaths with 79.49% dying in intrapartum period or within four hours after delivery and 28.20% at patients' home or on their way to hospital.

Adult↗
PubMed1976

Maternal mortality in an urban hospital. A fifteen-year survey.

A 15-year survey of maternal mortality in a large urban hospital revealed an overall rate of 2.95 deaths per 10,000 pregnancies (3.44 per 10,000 live births), representing 31 maternal deaths among approximately 105,000 deliveries and spontaneous and therapeutic abortions. This rate showed marked improvement during the 15-year period, ie, 6.56 per 10,000 pregnancies for the first 5 years as compared to only 1.37 per 10,000 pregnancies for the last 10 years. In contrast to the classic triad of causes of maternal death--toxemia, hemorrhage, and spesis--the principal cause of death in this series was amniotic fluid embolism. Other aspects of the causes of death and of the findings are discussed. Among the 32 fetuses, total fetal wastage was 63%, with a neonatal mortality of 8% and a fetal mortality of 46%.

Adult↗
PubMed2004

Maternal mortality in Bavaria between 1983 and 2000.

OBJECTIVE: This study was undertaken to identify the main causes of maternal mortality within a developed country to refocus and enhance the delivery of obstetric services. STUDY DESIGN: From January 1, 1983, to December 31, 2000, 309 maternal deaths occurring in Bavaria were documented and classified in a prospective observational study. The data sources were the civil registry, confidential reports by members of the Bavarian Society of Obstetrics and Gynecology, and public information. Direct obstetric death, indirect obstetric death, and coincidental death account for 164, 67, and 78 cases, respectively. They were expressed as the maternal mortality ratio (MMR: maternal deaths/100,000 live births) over the 18-year study period divided into three 6-year intervals 1983 to 1988, 1989 to 1994, and 1995 to 2000. RESULTS: The direct obstetric mortality ratio (DOMR: direct obstetric deaths/100,000 live births) decreased from 11.3 in the study period 1983 to 1988 to 5.4 in the study period 1995 to 2000 (P<.0005), mainly because of a reduction in antepartal and intrapartal deaths. The main cause of direct obstetric death was thromboembolism, including amniotic fluid embolism, which remained unchanged over the study period; other causes of direct obstetric death decreased markedly but not significantly. CONCLUSION: Careful analysis of the Bavarian maternal mortality data identified postpartum maternal deaths to be unchanged during the study period. In particular, effective prevention and treatment of thromboembolism should be a prior focus for obstetric care.

Embolism, Amniotic Fluid↗
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↗
PubMed2003

[Analysis of maternal mortality in China from 1996 to 2000].

OBJECTIVE: To study the trend and characteristics of maternal mortality in China from 1996 to 2000. METHODS: Population-based epidemiological survey in 116 monitoring units in China were used. RESULTS: Maternal mortality in China dropped by 17.1% from 63.9 per 100,000 live births in 1996 to 53.0 in 2000, in rural area dropped by 22.2% from 86.4 per 100,000 live births to 67.2, and in urban area only 1.0% from 29.2 per 100 000 live births to 28.9, the leading causes of maternal mortality in China are hemorrhage, preeolampsia/eclampsia and amniotic fluid embolism the maternal mortality due to hemorrhage in national level and rural level has declined by 33.8%, 34.9% respectively. CONCLUSION: The maternal mortality appears a declined trend on both the national and rural levels in China from 1996 to 2000, the maternal mortality due to hemorrhage dose also, bur the maternal mortality in urban area keeps unstable.

Cause of Death↗
PubMed1987

[Acute blood coagulation disorders in pregnancy--changing patterns in the disease picture].

The syndrome of coagulation defects in obstetrics was detected as cause for obstetrical hemorrhage during the 50 years. Some of the etiologic factors like the dead fetus syndrome or the salting out syndrome have vanished. Amniotic fluid embolism is the only syndrome which is clearly associated with disseminated intravascular coagulation. This connection between premature separation is less clear. One concept assumes that the plasma fibrinogen concentration is low because it is consumed in the retroplacental hematoma. Heparin treatment can be fatal if DIC is mistaken with a "loss coagulopathy", which is at present mostly responsible for coagulation defects and obstetrical hemorrhage. This indicates a change in pattern of disease which is due to a better pathophysiologic understanding.

Blood Coagulation Disorders↗
PubMed2003

[Four main reasons of maternal death in Poland between 1991-2000].

Maternal death during pregnancy, labour and puerperium constitutes the main problem of prenatal medicine and still a major public health topic. In this work we analyses maternal deaths in Poland between 1991-2000. There were 4,404,641 live births and 462 maternal deaths. Among them there were 402 direct ("true") maternal deaths with mortality rate 9.1 per 100,000 live births and 60 indirect maternal deaths (rate 1.4). There were 218 cases of pregnancy associated deaths (rate 4.9). The main causes of direct maternal deaths were as follows: haemorrhage--33.6% (rate 3.1), sepsis--27.3% (rate 2.5), amniotic fluid embolism--22.4% (rate 2.0) and pregnancy induced hypertension 16.7% (rate 1.5). Increasing maternal age is one of important risk factor for mortality. Over 30% of direct pregnancy related deaths were noted within women above 35 years. Unsatisfactory antenatal care, management deficiency and patient's neglect were main risk factor foe fatal outcome. Practical conclusions should be issued as general rules, instructions and recommendations. Between one third to one half of the maternal deaths are considered to have been preventable.

Adult↗
PubMed1992

[Diagnosis and management of obstetric acute disseminated intravascular coagulation].

Twenty-seven in-patients with obstetric DIC in our hospital from Jan. 1971 to Dec. 1990 were analysed retrospectively. The incidence was 0.12% in the first decade and 0.02%, in the second, showing a difference of significance between them. The most common predisposing factors included amniotic fluid embolism, abruptio placenta and hemorrhagic shock. Bleeding from multi-organs in various extent and coagulation disorders occurred in all those 27 cases. [Besides anti-shock treatment, heparin was employed together with fibrinogen in 4 postpartum and 1 antepartum DIC patients, fibrinogen alone in 8 cases, and hysterectomy in 11 cases. 17 patients were saved and 9 died. It is important that early diagnosis and much attention paid to clinical characteristics together with serial laboratory tests. Key management should include prompt treatment and eradication of predisposing factors. Quick decision spite of to terminate the pregnancy and even hysterectomy should be done in some risks.

Abruptio Placentae↗
PubMed1996

Inhaled aerosolized prostacyclin as a selective pulmonary vasodilator for the treatment of severe hypoxaemia.

Two case reports are presented where inhaled aerosolized prostacyclin (IAP) was used to good effect as a selective pulmonary vasodilator. It was used in the treatment of a patient with severe hypoxaemia secondary to amniotic fluid embolism and for hypoxaemia secondary to the acute respiratory distress syndrome (ARDS) in a patient with acute on chronic liver failure and intra-abdominal sepsis. An apparent dose-response curve is demonstrated in the second case. A dose of IAP of 30-40 ng/kg/min produced an effect on oxygenation in the patient with liver failure equal to that seen at the maximal dose of (50 ng/kg/min). Reduction in dose below 30 ng/kg/min resulted in a deterioration in oxygenation towards baseline/pre-treatment levels. Inhaled aerosolized prostacyclin is a potent pulmonary vasodilator with little or no systemic hypotensive effect. It is simple to administer and would appear to be a viable alternative to inhaled nitric oxide.

Administration, Inhalation↗
PubMedDate not supplied

Stroke in pregnancy and the puerperium.

Recent studies suggest that the risk of cerebral infarction is increased during the puerperium but not during pregnancy itself. Most of the known causes of ischaemic stroke in the young have been reported during pregnancy. In most of these conditions, it is uncertain whether pregnancy is coincidental or plays a role in the occurrence of stroke. Eclampsia is the main pregnancy-specific cause, which may be associated with focal neurological deficits of sudden onset, consistent with a clinical diagnosis of stroke. However, the precise pathogenesis of these stroke-like focal deficits remains poorly understood. The two other pregnancy-specific conditions (choriocarcinoma and amniotic fluid embolism) are rarely responsible for focal cerebral ischaemia. In a significant number of patients, the cause of the stroke remains undetermined, despite an extensive aetiological investigation. Whether a hypercoagulable state and vessel wall changes associated with pregnancy may play a role in the occurrence of these otherwise unexplained ischaemic strokes remains unknown. The occurrence of cerebral venous thrombosis is clearly linked to the puerperal state, suggesting a direct role of the latter. However, cerebral venous thrombosis during pregnancy or the puerperium has been related to various aetiologies, stressing the need for an aetiological study, particularly when the thrombosis occurs during pregnancy. Pregnancy may increase the risk of subarachnoid haemorrhage, The most common cause is rupture of an arterial aneurysm. Although this is a controversial issue, the increased tendency of an aneurysm to bleed with advancing gestational age suggests that haemodynamic, hormonal or other physiological changes of pregnancy may play a role in aneurysmal rupture. The classic notion that rupture of an arterial aneurysm occurs more frequently during labour has not been confirmed. Most authors agree that surgical management after subarachnoid haemorrhage in pregnancy should be the same as that in the non-pregnant state. Data specifically devoted to intraparenchymal haemorrhage in pregnancy are scarce. Pregnancy and in particular the puerperium seem to be associated with an increased risk of intracerebral haemorrhage. The most common causes are eclampsia and ruptured vascular malformations. Whether pregnancy increases the risk of rupture of an arteriovenous malformation is controversial.

Adult↗