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PubMed1994

Maternal mortality in Europe.

Maternal mortality rates (or ratios) are widely used as one indicator of the quality of medical care. There has been concern that conclusions may be drawn from unreliable data. A survey of practices in European countries confirms that there are differences in interpretation of definitions and evidence of significant under-reporting in official returns of vital statistics. Actual and potential sources of error are identified and a need for greater precision and uniformity of data collection is established.

Europe↗
PubMed2006

Knowledge gaps in scientific literature on maternal mortality: a systematic review.

Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown.

Cause of Death↗
PubMed2000

Maternal mortality in New York City: excess mortality of black women.

To assess maternal mortality in New York City, birth certificates and mortality records for New York City from 1988 through 1994 were linked and examined. During these 7 years, maternal mortality in New York City (defined by the International Classification of Diseases, 9th edition [ICD-9], as 630-676) per 100,000 live births significantly exceeded that of the country as a whole (20.2 vs. 8.2, respectively). Within New York City, an even greater variation of maternal mortality by race/ethnicity was noted, with the mortality ratio of whites, blacks, and Hispanics being 7.1, 39.5, and 14.4 per 100,000 live births, respectively. Socioeconomic characteristics such as educational attainment, marital status, and income influenced maternal mortality more in non-blacks than blacks. Analyses of cause-specific mortality revealed that, overall, ectopic pregnancy, embolism, and hypertension were the leading causes of death. However, the major factors explaining the excess maternal mortality among blacks were hypertension (mortality ratio of blacks to whites 5.57, 95% confidence interval 2.30-13.39), ectopic pregnancy (4.78, 95% confidence interval 2.40-9.51), and abortion (4.58, 95% confidence interval 1.72-12.22). These findings confirm a persisting gap in maternal death between black and white women. Indeed, if all New Yorkers who became pregnant enjoyed the survival of the city's non-Hispanic white residents, the difference in maternal mortality between the city and the nation would be eliminated.

Adolescent↗
PubMed2006

[Maternal mortality on the family members' perspective].

Maternal mortality is one of the health and social development indicators for countries. It is a tragedy for the family, as the death of a mother deprives the child of breastfeeding and maternal contact and also due to the fact that women maintain family unity. This study is aimed at understanding the meaning of death for the family members of women who have died. The population was formed by 10 family members of 7 women who died as a result of maternal problems in the municipality of Ribeirão Preto. The authors visited their homes and collected data through interviews. For analyzing the data the authors used thematic analysis. Three thematic categories were found: the meaning of maternal mortality; living maternal mortality in the family; and living maternal mortality in the health services. The visit confirmed that there are secondary factors that influenced in the occurrence of maternal deaths.

Death↗
PubMed1987

Maternal mortality in the Maltese Islands.

Maternal mortality statistics from the Maltese Islands since 1935 are reviewed to show that there has been a marked decrease in maternal mortality rates. This decrease is probably related to reductions in family size and improvements in the perinatal care of mothers. Hypertensive disease is now the most important cause of maternal mortality.

Adult↗
PubMed2006

[The UN Millennium Project; especially the prevention and treatment of the HIV-virus and AIDS in order to reduce child and maternal mortality].

Reducing child and maternal mortality are important UN Millennium Development Goals. The AIDS epidemic, which is targeted in another Millennium Development Goal, has a negative influence on child and maternal health. Although on a mondial level, the influence of HIV/AIDS on child and maternal mortality appears to be slight, HIV/AIDS constitutes a significant factor in Sub-Saharan Africa. In the Netherlands, the introduction of aggressive antiretroviral therapy has reduced the chance of vertical transmission to < 1%. In low-wage countries, financial means and political commitment for similar handling are lacking. Possible strategies for the prevention of vertical transmission for these countries are as follows: multivitamin supplements during pregnancy, prophylaxis against opportune infections with cotrimoxazol, a vaginal douche with chlorhexidine for cases where the membranes have ruptured more than 4 hours previously, and a single dose of nevirapine.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Determinants of maternal mortality in the developing world.

Maternal mortality is the culmination of a series of detrimental events in a woman's life, pregnancy being the last one. The underlying pathology is the lack of education, sanitation, accessible health care, as well as poor nutrition and poverty. These affect women during pregnancy and childbirth when they are more vulnerable. This 10-year review of literature from the developing world focuses on, and discusses the determinants of maternal mortality. Methods of reducing maternal mortality through policy addressing health care needs are touched on.

Cultural Characteristics↗
PubMed2006

Factors associated with anaesthesia-related maternal mortality in a tertiary hospital in Nigeria.

BACKGROUND: Maternal mortality related to anaesthesia is low compared with that resulting from obstetric factors in developed countries. The role of anaesthesia in maternal mortality in developing countries is obscure. The purposes of this study were to determine the incidence of maternal mortality related to anaesthesia, to analyse the causes and to suggest measures to improve anaesthetic safety for parturients. METHODS: The hospital surgical registry was reviewed from 1 January 1991 to 31 December 2000 to identify patients who had undergone surgical procedures in pregnancy or puerperium. Data were obtained from the surgical registry in the Labour and Delivery Suite, Intensive Care Unit records and maternal mortality database to determine the demographic characteristics and anaesthetic technique. Maternal mortality after surgical procedures was further scrutinized to evaluate the anaesthetic care and the contribution of anaesthesia to mortality. RESULTS: A total of 12,394 deliveries occurred in the hospital during the period under review. Caesarean section accounted for 2323 deliveries (18.7%). Eighty-four maternal mortalities were recorded, with a maternal mortality rate of 678 per 100,000 deliveries. Infection, haemorrhage, pre-eclampsia/eclampsia and anaesthesia were the leading causes of maternal mortality. Anaesthesia was the sole cause of six maternal deaths. The patients received general anaesthesia for the surgical procedure. CONCLUSION: Difficult airway management during general anaesthesia, inadequate supervision of trainee anaesthetists and a lack of appropriate monitors were the major anaesthetic reasons for maternal mortality. Recommendations have been made to ensure that parturients and the unborn child receive the best anaesthetic care attainable in the hospital.

Adult↗
PubMed1987

Death rates from stroke in England and Wales predicted from past maternal mortality.

Geographical differences in maternal mortality in England and Wales during 1911-4 correlate closely with death rates from stroke in the generation born around that time. The geographical distribution of stroke is more closely related to past maternal mortality than to any leading cause of death, past or present, except ischaemic heart disease, for which correlation coefficients with stroke are similar. This relation is new evidence that poor health and physique of mothers are important determinants of the risk of stroke among their offspring.

Aged↗
PubMed1993

[Maternal mortality in Peru].

The author investigates maternal mortality in Peru using data from the second Demographic and Family Health Survey (ENDES-II) carried out in 1991-1992. "The inclusion of a module about adult mortality in the questionnaire of the ENDES II [made it possible] to estimate maternal mortality using a set of questions about the sisters of the women interviewed. The study highlights the inverse relation between levels of maternal mortality and education, [especially] the relevance of formal education for decreasing the incidence of maternal mortality." (SUMMARY IN ENG)

Americas↗
PubMed1990

Misreporting of maternal mortality in Puerto Rico.

Maternal mortality (MM) continues to be a problem that plagues many developed and underdeveloped countries around the world. It has been estimated that the minimum amount of underreporting in the U.S. to be 20%, resulting in MM rates that may be substantially higher than reported. The national goal for the MM for the year 1990 has been set at 5/100,000, and at the present trend it is expected that this may be achieved among the white population, but not among minorities. P.R. reported a maternal mortality rate of 5/100,000 in 1975. It was suspected that such a low rate was due to underreporting, a study was undertaken to investigate that possibility. The results indicated that there was severe underreporting of maternal deaths during 1978 = 79. Recently, there has been a growing concern that the level of underreporting in PR continues to be high. Since there has been no evidence that the surveillance has improved, the Dept. of Health requested from the Dept. of Ob-Gyn of the University of Puerto Rico Medical School and the Dept. of Maternal and Child Health to conduct a study to find out if the previous findings held true for recent years. The study was based on the review of selected medical records corresponding to deaths of women of childbearing age whose causes of death, as coded in the death certificate, were considered as having a high probability of masking a misreported maternal death. It was decided to investigate those deaths occurring in 1982, to see if the results of the previous study had caused any impact on the surveillance of maternal deaths in Puerto Rico.

Death Certificates↗
PubMedDate not supplied

The Bali Indirect Maternal Mortality Study.

The Bali Indirect Maternal Mortality Study (BIMMS) was conducted in Bali Province, Indonesia in 1991. The objective of the study was to evaluate the indirect sisterhood method for estimating maternal mortality, using a prospective (direct) community-based survey undertaken from 1980 to 1982 among women of reproductive age (Reproductive Age Mortality Survey, or RAMOS) as a comparison. The BIMMS maternal mortality ratio was 331 per 100,000 live births adjusted for 1982. This ratio is similar to the RAMOS one prior to its adjustment, of 359 per 100,000 live births. The sisterhood method was faster, cheaper, and appears to be as accurate as direct methods.

Adolescent↗
PubMed1997

Maternal mortality in rural Zambia.

OBJECTIVE: To assess maternal mortality. DESIGN: Sisterhood method survey and hospital data. SETTING: Communities in Kalabo District, a very remote rural area in western Zambia; Kalabo District Hospital. RESULTS: The number of respondents in the sisterhood method survey was 1,978. The estimated maternal mortality ratio derived from this survey was 1,238 per 100,000 live births. The hospital study involved 2,474 deliveries of 2,374 live babies. The official number of maternal deaths was 13. Further investigation of files revealed an additional 15 maternal deaths, bringing the institutional maternal mortality rate from 548 to 1,179 per 100,000 live births. The major causes of direct maternal deaths were obstructed labor and sepsis. In 71% of all cases substandard care factors contributed. CONCLUSIONS: Maternal mortality in rural Zambia is among the highest as reported in the world. Official hospital data tend to underestimate maternal mortality in the community due to underreporting. The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural areas of developing countries.

Adolescent↗