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PubMed1998

Reproductive age mortality survey to study under-reporting of maternal mortality in Surinam.

OBJECTIVES: A nationwide confidential enquiry into maternal deaths was carried out in Surinam during the years 1991-1993. Preliminary analysis showed a maternal mortality ratio (MMR) of 240 per 100000 live births, which was almost four times higher than the official MMR for the preceding decade. The question arose whether maternal deaths had been under-reported for the years 1981-1990. For these 10 years official statistics revealed 65 maternal deaths. METHODS: For the period 1981-1990 a retrospective reproductive age mortality survey was carried out in five urban hospitals covering 78% of all deliveries in Surinam. RESULTS: In these hospitals 1216 women of age 10-49 years died. Due to disorganized filing 439 medical records (36%) could not be traced. By reviewing 64% of the records, 85 maternal deaths were identified (70 direct and 15 indirect). CONCLUSION: Although only 64% of medical records could be reviewed, the number of maternal deaths identified in five hospitals (85) was 1.3 times higher than the officially reported number for the whole country (65). Maternal mortality was found therefore to be under-reported in Surinam for the period 1981-1990.

Adolescent↗

PubMedDate not supplied

An assessment study of maternal mortality ratio databank in five districts of North Western Frontier Province Pakistan.

BACKGROUND: Maternal mortality ratio is an indicator to measure the summary of information about mother and child health. It is estimated that about 500 maternal deaths occur per 100,000 live births each year in Pakistan. It is a well known fact that all health statistics coming out of the developing countries are calculated "guesstimates" some are perhaps more close to the real figures than the others. There is a dire need to help generate information that can be used by health professionals, health care planners and managers to save women's lives by improving the quality of care provided to turn away maternal mortality. The maternal mortality ratio for Pakistan as well as for NWFP is projected as 533/100,000 live births for the year 1990-91 produced by National Institute of Population Studies, Pakistan. METHODS: This was a retrospective cross-sectional quantitative study for the period (2001-2002) conducted in five districts of (NWFP) North Western Frontier Province, Pakistan. RESULTS: National HMIS data opened the maternal mortality ratio for; Haripur as 0.168 and 0.173, Mansehra 00 and 00, Battagram 00 and 00, Swat 0.051. and 0.524 and Swabi 00 and 0.968 per/1000 live births, respectively. The small part exercise outcome (the study) endorsed more shadowy side of the actual maternal mortality ratio for the same period in the same districts. CONCLUSION: In our country there is a urgent need to institute an efficient mode of operation to get accurate maternal mortality database. Verbal Autopsy method is cost effective and feasible approach for implementation in a country like Pakistan.

Adult↗

PubMed2005

Appropriate technology to prevent maternal mortality: current research requirements.

Maternal mortality involves a complex mixture of clinical, infrastructural and social issues and will require a multifaceted approach if we are to see meaningful reductions occur. That includes thoughtful attention to appropriate technologies for low-resource countries. An international group of specialists meeting in Bellagio, Italy, in 2003 identified important needs and opportunities related to new and underutilized technologies to reduce pregnancy-related mortality. Research to fill in critical information gaps was a recurrent theme. Research, whether it is for product development, for building the evidence base about effectiveness and safety or for helping refine introduction strategies and guide practice, plays a critical role in the development and widespread use of technologies. Priority research needs related to the five major causes of maternal mortality-haemorrhage, puerperal sepsis, unsafe abortion, pre-eclampsia and eclampsia and obstructed labour-have been identified. Appropriate collaborations of investigators and other stakeholders and adequate financial resources are urgently needed to move the research agenda forward.

Abortion, Induced↗

PubMed2000

Maternal mortality, United States and Canada, 1982-1997.

BACKGROUND: The 1998 public awareness campaign on Safe Motherhood called attention to the issue of maternal mortality worldwide. This paper focuses upon maternal mortality trends in the United States and Canada, and examines differentials in maternal mortality in the United States by maternal characteristics. METHODS: Data from the vital statistics systems of the United States and Canada were used in the analysis. Both systems identify maternal deaths using the definition of the World Health Organization's International Classification of Diseases. Numbers of deaths, maternal mortality rates, and confidence intervals for the rates are shown in the paper. RESULTS: Maternal mortality declined for much of the century in both countries, but the rates have not changed substantially between 1982 and 1997. In this period the maternal mortality levels were lower in Canada than in the United States. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. Maternal mortality rates have been stable recently, despite evidence that many maternal deaths continue to be preventable. Additional investment is needed to realize further improvements in maternal mortality.

Adult↗

PubMed1987

A thirty-year review of maternal mortality in Oklahoma, 1950 through 1979.

Oklahoma's Maternal Mortality Committee has been active since 1941. During the 30-year period 1950 through 1979, the committee reviewed in detail 75.9% of the pregnancy-related deaths that occurred in Oklahoma. The maternal mortality ratio in 1950 was 95.1/100,000 live births, and for 1979 it was 8.1/100,000 live births, a decrease of 91.5%. The risk of death from childbearing remained greater for black women than for American Indian or white women throughout the three decades. For American Indian women, the risk of death associated with pregnancy has decreased and is almost equal to the risk for white women. The Maternal Mortality Committee estimated that two thirds of Oklahoma's maternal deaths were preventable. The proportion of deaths judged preventable did not vary substantially during the study period. We conclude that maternal mortality in Oklahoma can be reduced to fewer than three deaths per 100,000 live births. Intensive monitoring and investigation of deaths and their causes by local maternal mortality committees continues to be an important mechanism for obtaining information to assist health workers in the prevention of deaths.

Black or African American↗

PubMed2000

Strategies to reduce maternal mortality worldwide.

The challenge of reducing maternal mortality is increasingly being addressed by area-based efforts to improve access to care of obstetric emergencies. Improving coverage and quality of skilled attendance at birth is also being increasingly emphasized. Post-abortion care, better reproductive health services for adolescents, and improved family planning care are important ingredients in maternal mortality reduction. New developments in malaria, nutrition, violence and HIV/AIDS in relation to maternal health are highlighted, as well as measurement issues. Maternal mortality reduction is also being promoted today by using a human rights approach.

Female↗

PubMed1991

[Maternal mortality due to heart disease].

A retrospective study on maternal mortality in pregnant women with cardiac disease over a period of eleven years (January 1979 to December 1989) was undertaken. The objective was an analysis of the main aspects of this association. Cardiac disease was diagnosed in 694 patients (4.2%) of a total of 16,423 admitted to the Obstetrics Department of the Escola Paulista de Medicina. As for etiology, rheumatic disease (52.3%); Chagas's disease (19.3%) and congenital disease (8.1%) were the most frequent causes. There were 51 maternal deaths, according to FIGO's definition (1967), corresponding to a maternal mortality rate of 428.2/100,000 livebirths during the same period. Twelve of these maternal deaths were due to cardiac disease (maternal mortality rate of 100.8/100,000 livebirths). The statistical analysis identified the following aspects associated with maternal mortality among patients with cardiac disease: primigravida, lack of adequate prenatal care, and cardiac surgery performed previously to and/or during pregnancy. Congestive heart failure with pulmonary edema (41.7%) and thromboembolism (25.0%) were the most frequent causes of maternal death among patients with cardiac disease. The NYHA functional classification was not a good parameter for pregnancy prognosis: eleven patients (91.7%) were considered as belonging to the favorable group before they became pregnant. Most maternal deaths occurred during the first 72 hours after delivery. Therefore, this period was considered most critical for maternal mortality in patients with cardiac disease. No relation-ship was found among the factors: maternal age, race, marital status, delivery and maternal mortality among patients with cardiac disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Brazil↗

PubMed2004

[The reduction in maternal mortality in Chile, 1990-2000].

OBJECTIVE: To determine if Chile achieved the objective of reducing maternal mortality by 50% between 1990 and 2000, in line with the provisions of the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas, which the governments of the Americas approved in 1990 at the 23rd Pan American Sanitary Conference. METHODS: A descriptive, observational study was designed, making it possible to analyze the trend in maternal mortality in Chile from 1990 through 2000. The variables that were evaluated were the maternal mortality ratio, the causes of death, and the age of the mothers who died. The causes of death were classified according to the ninth revision of the International Classification of Diseases (ICD-9), and the raw data were obtained from the yearbooks of the National Institute of Statistics of Chile. The changes in the variables were estimated according to the percentage of cumulative change, and trends were analyzed with the Pearson correlation coefficient. RESULTS: The study found a 60.3% reduction in maternal mortality from 1990 to 2000. The lowest maternal mortality ratio, 18.7 per 100 000 live births, occurred in the year 2000. The five leading causes of maternal mortality were hypertension, miscarriage, other current conditions in the mother, puerperal sepsis, and postpartum hemorrhage. There was a significant downward trend in maternal mortality due to hypertension (r = -0.712; P = 0.014), abortion (r = -0.810; P = 0.003), and puerperal sepsis (r = -0.718; P = 0.013), but there were no statistically significant changes in mortality from other current conditions in the mother or from postpartum hemorrhage. The highest level of maternal mortality was found in women who were 40 years of age or older (100.2/100 000 live births), and the lowest level was in adolescents 15 to 19 years old (18.7/100 000 live births). CONCLUSIONS: Chile achieved the objective of the Regional Plan of Action for the Reduction of Maternal Mortality in the Americas, with a decrease of more than 50% in maternal mortality in the 1990-2000 period. That reduction is due mainly to the decline in maternal mortality from hypertension, abortion, and puerperal sepsis.

Adolescent↗

PubMed1993

Maternal mortality in Mississippi: 1987-1991.

OBJECTIVE: To characterize the maternal mortality in the state of Mississippi for 1987-1991 and compare the maternal mortality from 1977-1986 with that of the last 5 years. STUDY DESIGN: Factors associated with maternal mortality were obtained from death certificates, replies to questionnaires, medical records, and autopsy reports. RESULTS: The maternal mortality rate in Mississippi for 1987-1991 (14.1/100,000) was not significantly different than for 1977-1986 (11.8/1000,000; P = 0.45). Over the last 5 years there was an increased incidence of direct obstetric deaths (50% vs 73%). During 1987-1991, toxemia as a cause of death for parturients decreased, while hemorrhage as a cause of maternal death increased. There was a rise in the incidence of patient related factors which were avoidable and which led to several deaths during 1987-1991. CONCLUSION: The state's maternal mortality rate remains stable. Improved patient and health care provider's education are necessary to further decrease the incidence of maternal death in Mississippi.

Female↗

PubMed2000

Can poor countries surmount high maternal mortality?

Does poverty bind developing countries to high levels of maternal death in childbirth? Or, as safe-motherhood advocates claim, do public health and social policy interventions have the potential to accelerate maternal mortality transitions? Globally, almost one in 200 live births leads to the death of the mother, making maternal mortality an issue of critical international import. This article presents an analysis of the determinants of national maternal mortality levels with a view to shedding light on these questions. A cross-national regression of 64 countries shows that wealth indicators explain only a portion of the variance in national maternal mortality levels. Other determinants, including women's educational levels and the proportion of deliveries attended by trained health personnel, are more clearly associated with national maternal mortality levels than are measures of wealth. The results offer grounds for optimism concerning the potential for global safe-motherhood efforts to induce maternal mortality transitions.

Developing Countries↗

PubMed2000

Maternal mortality in the past and its relevance to developing countries today.

High maternal mortality was a feature of the Western world from the mid-19th century, when reliable record keeping commenced, to the mid-1930s. During this time, maternal mortality rates tended to remain on a high plateau, although there was wide disparity between countries in the height of the plateau. From approximately 1937, maternal mortality rates began to decline everywhere, and within 20 y, the intercountry differences had almost disappeared. The decline in maternal mortality rates was so dramatic that current rates for developed countries are between one-fortieth and one-fiftieth of the rates that prevailed 60 y ago. In this paper, the reasons for the high mortality before 1937 and its decline since that date are discussed. It is suggested that the main determinant of maternal mortality was the overall standard of maternal care provided by birth attendants. Poverty and associated malnutrition played little part in determining the rate of maternal mortality. This view is supported by much evidence, including the fact that, unlike for infant mortality rates, maternal mortality rates tended to be higher in the upper than in the lower social classes. The potential relevance of these findings to developing countries is discussed.

Developing Countries↗

PubMed1991

Maternal mortality surveillance--Puerto Rico, 1989.

Maternal mortality is substantially underreported in the United States and throughout the world. In Puerto Rico, the 1989 revised death certificate contained a new item that asked whether a decedent had been pregnant within the past year. This information enabled a panel of experts to identify and review all death certificates for females aged 10-49 years who had been pregnant within 1 year before death. This report describes how the new item on the birth certificate can be used to improve maternal mortality surveillance in Puerto Rico.

Adolescent↗

PubMed1992

Maternal mortality: community-based interventions.

Maternal mortality is one of the great neglected problems of health care in developing countries. The World Health Organization estimates that approximately 500,000 women die each year from pregnancy-related causes, over 98% of these deaths occurring in the developing world, where maternal mortality is as much as 100 times higher than rates seen in industrialized countries. The most common causes include obstructed labor and ruptured uterus, postpartum hemorrhage, eclampsia, postpartum infection and complications of illegal abortion. It is suggested that no new or costly technologies are needed; rather that appropriate priority setting and allocation of needed resources are essential to the solution of the problem. There are few interventions that hold much hope of success at the village level, although antibiotics, ergotrate, and sedatives might be productively utilized, after appropriate training. Overall, however, networks of maternity care facilities, trained personnel, and means of transport are necessary to provide needed emergency maternity care services.

Democratic Republic of the Congo↗

PubMed2007

Seasonal variations in maternal mortality in Maputo, Mozambique: the role of malaria.

OBJECTIVE: To evaluate the impact of malaria on maternal death through the analysis of the seasonal variations of crude and malaria-specific maternal mortality rates. METHODS: All maternal deaths and live births occurring at Maputo Central Hospital, located in an urban area, between January 2001 and December 2003, were retrospectively recorded. Clinical diagnoses of the causes of death and period of the year were analysed. RESULTS: Two hundred and seventy-eight deaths were recorded. The overall crude maternal mortality rate was 995/100 000 live births. Malaria was the most frequent cause of maternal death, accounting for 23%. Crude and malaria-specific maternal mortality rates showed a similar pattern of seasonal variation, with peaks at the beginning and the end of the malaria transmission season. The malaria-specific maternal mortality rate was significantly higher during the rainy seasons (rate ratio 1.919; 95% CI 1.061, 3.470; P = 0.031). CONCLUSIONS: Malaria may contribute to maternal mortality in highly endemic countries in sub-Saharan Africa, at least in urban areas. Efforts to improve malaria control in pregnancy may have an impact on maternal mortality in sub-Saharan Africa.

Adult↗

PubMed1992

[Infant and maternal mortality rates in Indonesia].

"Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) are usually used as indicators of social development. This paper reviews the situation of both indicators in Indonesia, based on various methods and data resources. The result of the study shows the high inequality of interregional mortality indicated by the trend of IMR and the differentials in IMR and MMR." (SUMMARY IN ENG)

Asia↗

PubMed1990

Maternal mortality in New York City, 1981-1983.

The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. Fifty-seven deaths were associated with cesarean delivery, although most of these could not be attributed to the mode of delivery. Sixty-six (55%) of the deaths were classified as direct maternal deaths. The age ranged from 16-44 years, with 83 (69%) of the women aged 20-34, 11 (9%) 19 or less, and 26 (22%) aged 35 or older. Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.

Adolescent↗

PubMed2003

Estimates of maternal mortality in western Tanzania by the sisterhood method.

Maternal mortality in Kigoma Region, western Tanzania, was assessed as part of ongoing efforts to reduce maternal deaths in the area. A sisterhood survey was carried out using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within six weeks after childbirth. Three thousand and twenty nine individuals were interviewed. The overall estimated maternal mortality ratio (MMR) in Kigoma Region was 606 per 100,000 live births (95% CI 518-695). In urban areas, the MMR was 447 (95% CI 262-635), compared to 638 (95% CI 539-737) in rural areas. The highest NMR of 757 was found in Kigoma rural district, the most isolated part of the region (95% CI 599-916). Although the differences are not statistically significant, they may indicate poor accessibility as a risk factor. Maternal mortality in Kigoma is high when compared to other regions in Tanzania. The sisterhood method is relatively simple and convenient for estimating maternal mortality in resource-poor countries.

Adolescent↗

PubMedDate not supplied

Tropical obstetrics and gynaecology. 2. Maternal mortality.

Estimates of maternal deaths per 100,000 births are 270 for Latin America, 420 for Asia and 640 for Africa, compared to only 30 in developed countries. In places with high maternal death rates, women who fail to receive antenatal care and who then report to hospital only when their lives are threatened by major obstetric complications constitute the crux of the problem. In reducing maternal deaths in such places, especially in Africa, the need is to provide vigorous treatment for the unbooked emergencies and, at the same time, work towards the removal of the cultural, health and socio-economic conditions which create the unbooked emergencies. The first objective can be achieved through developing a network of first referral hospitals so that life saving measures are accessible to all who need them before it is too late. The second objective can be realized only through the universal provision and utilization of basic but professional antenatal care and also through modernization of the society as a whole. For all of these goals, universal formal education is fundamental.

Africa↗