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PubMed2000

Maternal mortality associated with eclampsia and severe preeclampsia of pregnancy.

OBJECTIVE: To analyse factors associated with maternal mortality in eclampsia and preeclampsia. METHOD: Retrospective analysis of 69 maternal deaths due to (eclampsia-61; severe preeclampsia-8) was carried out during a period of 17 years (1982-1998). Maternal condition on admission, associated complications and principal cause of death was analysed in each case. RESULTS: Mean time interval between hospitalization and maternal death was 49.56 +/- 62.01 hrs (1-240 hrs). Twenty (28.9%) women died undelivered. Twenty-three (37.7%) women were in grade IV coma and 52.4% of eclampsia patients had recurrent convulsions (> 10) prior to admission. Associated complications in form of hemorrhage, cerebrovascular accidents, acute renal failure, jaundice, aspiration pneumonia and pulmonary oedema were 30.4, 31.8, 34.8, 18.8, 17.8, and 5.8%, respectively. Maternal mortality in eclampsia was significantly low in time period B (4.1%) when magnesium sulphate was used as an anticonvulsant. CONCLUSIONS: Maternal condition on admission and associated complications are the major determinant of maternal outcome. Use of magnesium sulphate is associated with significant reduction of maternal mortality.

Adult↗
PubMedDate not supplied

A framework for analyzing the determinants of maternal mortality.

Hundreds of thousands of women in developing countries die each year from complications of pregnancy, attempted abortion, and childbirth. This article presents a comprehensive and integrated framework for analyzing the cultural, social, economic, behavioral, and biological factors that influence maternal mortality. The development of a comprehensive framework was carried out by reviewing the widely accepted frameworks that have been developed for fertility and child survival, and by reviewing the existing literature on maternal mortality, including the results of research studies and accounts of intervention programs. The principal result of this exercise is the framework itself. One of the main conclusions is that all determinants of maternal mortality (and, hence, all efforts to reduce maternal mortality) must operate through a sequence of only three intermediate outcomes. These efforts must either (1) reduce the likelihood that a woman will become pregnant; (2) reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth; or (3) improve the outcomes for women with complications. Several types of interventions are most likely to have substantial and immediate effects on maternal mortality, including family planning programs to prevent pregnancies, safe abortion services to reduce the incidence of complications, and improvements in labor and delivery services to increase the survival of women who do experience complications.

Family Planning Services↗
PubMed2003

[Maternal mortality: epidemiology, risk factors and evitability. About ten cases].

OBJECTIVES: To determine maternal mortality rate during the last decade as revealing the quality of obstetrical follow-up and the necessary measures to be taken. PATIENTS AND METHODS: A retrospective study conducted in the department of gynaecology in the military hospital in Tunis between 1990 and 2001, permitted to count 10 cases of maternal death. RESULTS: Maternal mortality rate was about 33.72/100,000 live births. Mean age of patients was 31.2 years. Primiparity, multiparity, poor socio-economic conditions, high-risk pregnancies and bad follow-up were responsible in 5, 1, 6 and 3 cases and represent the risk factors of mortality. All deaths occurred after delivery, with 60% before 24 h. Causes of death were haemorrhage in 40%, gravidic hypertension in 20%, anesthetic accidents in 10%, acute hepatic failure in 10%, and infection in 10%. Indirect causes are responsible for 20% of cases. DISCUSSION AND CONCLUSION: Deaths were judged evitable in 66.6% of cases, which confirms, although maternal mortality has diminished in the recent past, the necessity of pursuing study of risk factors together with study of remedies to them.

Adult↗
PubMed2005

Personal accounts of 'near-miss' maternal mortalities in Kampala, Uganda.

OBJECTIVE: To explore the socio-economic determinants of maternal mortality in Uganda through interviews with women who had 'near-misses'. DESIGN: Observational study using qualitative research methods. SETTING: The postnatal and gynaecology wards of a large government hospital in Kampala, Uganda. SAMPLE: Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre-eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4). METHODS: The semi-structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software. RESULTS: The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women's attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health-seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhumane care. There were no reports of bribery. CONCLUSIONS: Women with near-miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality.

Adolescent↗
PubMed2000

Estimates of maternal mortality by the sisterhood method in rural nothern Tanzania: a household sample and an antenatal clinic sample.

OBJECTIVE: To estimate maternal mortality in two samples of a population in northern Tanzania. SETTING: Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania. POPULATION: From a household survey 2,043 men and women aged 15-60, and from an antenatal clinic survey 4,172 women aged 15-59. METHOD: The indirect sisterhood method. MAIN OUTCOME MEASURES: The risk of maternal deaths per 100,000 live births (maternal mortality ratio), and the lifetime risk of a maternal death. RESULTS: The risk of a maternal death per 100,000 live births was 362 (95% CI 269-456) and 444 (95% CI 371-517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237-413) compared with 561 (95% CI 446-677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively. CONCLUSIONS: The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.

Adolescent↗
PubMed1992

The untold story: how the health care systems in developing countries contribute to maternal mortality.

This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

Abortion, Legal↗
PubMed2005

Current strategies for the reduction of maternal mortality.

The purpose of this article is to review current strategies for the reduction of maternal mortality and the evidence pertinent to these strategies. Historical, contextual and current literature were examined to identify the evidence base upon which recommendations on current strategies to reduce maternal mortality are made. Current safe motherhood strategies are designed based mostly on low grade evidence which is historical and observational, as well as on experience and a process of deductive reasoning. Safe motherhood strategies are complex public health approaches which are different from single clinical interventions. The approach to evidence used for clinical decision making needs to be reconsidered to fit with the practicalities of research on the effectiveness of strategies at the population level. It is unlikely that any single strategy will be optimal for different situations. Strengthening of the knowledge base on the effectiveness of public health strategies to reduce maternal mortality is urgently required but will need concerted action and international commitment.

Abortion, Induced↗
PubMed1981

[Maternal mortality in the Rheinische Landesfrauenklinik Wuppertal from 1917 to 1979 (author's transl)].

From 1917 to 1979, the maternal mortality in the Rheinische Landesfrauenklinik Wuppertal has been investigated on the basis of 136084 live births. From 1917 to 1921, it was 10.1% and decreased to 0.16% in the period from 1973 to 1979. The maternal mortality in association with caesarean section, which was 11.8% in the period from 1917 to 1921 with a frequency of caesarean sections of 2.5%, decreased to zero since 1973 with a frequency of 6.3%. A caesarean section preceded more than 50% of the deaths since 1962. Most of the decreased (24.4%) were in the group of 30-34 years of age and 48.3% aged more than 30 years. 51.5% were primiparas and 14.6% of the women were at least para 4's. From 1917 to 1936, infection was the main cause of maternal mortality with 39.6%; from 1957 to 1966, however, thrombo-embolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anaesthetic deaths. During all the examined periods, non-specific reasons of maternal mortality were an important factor with more than 30%.

Age Factors↗
PubMed2003

Maternal mortality in developing countries.

Of all health statistics mentioned by the World Health Organization (WHO), maternal mortality is unique in showing the largest discrepancy between developed and developing countries. Approximately 90% of maternal deaths (more than 0.5 million each year) occur in developing countries. Over the last century, almost all countries have accepted antenatal care principles. However, insufficiency of resources and lack of women's compliance were the main handicaps in developing countries and compelled these countries to apply various standard programs. Unfortunately, these programs are not sufficiently effective in the prevention and treatment of maternal mortality. Fixing the number (quantity) of antenatal visits and the static approach affect the "quality" of antenatal care. Bleeding, chronic anemia, hypertensive disorders, obstructed labor, unsafe abortions and infections are the main factors leading to maternal mortality. The majority of these factors are preventable. It is important to suspect the presence of any of these factors and to intervene promptly both during antenatal care and immediately after delivery. The evidence-based approach is a way of reaching this solution. Antenatal care is a concept that extends from pre-pregnancy to postpartum, leading to effective emergency care for unpredictable and predictable complications during pregnancy and childbirth. Worldwide policies are not always applicable to each country, coercing national policies. There is still a need for prospective randomized trials to clarify this concept and the relevant policies.

Developing Countries↗
PubMed2004

[Maternal mortality in rural areas of China].

OBJECTIVE: To understand with clearness the trend and epidemiological characteristics of maternal mortality, as well as the leading causes of maternal deaths in rural areas of China from 1996 to 2001. METHODS: The data analyzed were those from the population-based epidemiological survey conducted by the national maternal mortality surveillance network which covered a total population of about 35,000,000 in China. RESULTS: The maternal mortality ratio (MMR) in rural areas of China dropped by 28.4% from 86.4 per 100,000 live births in 1996 to 61.9 in 2001. The leading causes of maternal deaths were obstetric hemorrhage, preeclampsia and embolism of amniotic fluid. The MMR for obstetric hemorrhage decreased from 48.3 per 100,000 live births in 1996 to 33.0 in 2001. The pregnant women mainly gave childbirths and died in their home, accounting for 44.6% and 30.1% respectively in 2001. CONCLUSION: The MMR showed a downward trend in rural areas of China during the period from 1996 to 2000, and so also did the MMR for obstetric hemorrhage. Reducing obstetric hemorrhage and increasing the rate of hospitalized delivery are the most important methods for reducing the MMR in rural areas in China.

Adult↗
PubMed2005

[Analysis on the potential losses of maternal mortality in Sichuan province in 2003].

OBJECTIVE: To explore the years of potential life lost (YPLL), working lost, valued lost from the main causes of maternal mortality. METHODS: We collected the mortality cases and live births by the surveillance network of maternal mortality in Sichuan province in 2003, and calculated YPLL, average years of life lost (AYLL), working years of potential life lost (WYPLL), valued years of potential life lost (VYPLL) caused by the death. RESULTS: In 2003, YPLL, AYLL, WYPLL, VYPLL of the maternal mortality were 4016, 43, 2305 and 2608 respectively. CONCLUSIONS: The ages of the maternal mortality were young, and the potential losses were significant. This not only threatens the life of women, but also is vital losses to the society and economy.

Adult↗
PubMed1992

Maternal mortality in Assiut.

Twenty-nine maternal deaths were identified among 8656 pregnant women residing in Assiut city and three surrounding villages (Upper Egypt). This gives a maternal mortality ratio of 368 per 100,000 live births. Of these maternal deaths 83% were due to direct obstetric causes (hemorrhage, eclampsia, ruptured uterus and sepsis). Logistic regression analysis showed that residence (in villages versus Assiut city), parity (nullipara and grandmultipara) and illiteracy were significantly associated with increased risk of maternal death.

Adult↗
PubMedDate not supplied

Maternal mortality in the University of Port Harcourt Teaching Hospital, Port Harcourt in the last year before the new millennium.

BACKGROUND: Maternal death in developing countries is still high and the causes are multifactorial. The unbooked primigravidae with severe pre-eclampsia/eclampsia constitute a high risk group. METHODS: The data from case notes of all maternal deaths which occurred at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt between 1st of January and 31st of December 1999 formed the basis of this study. Case notes of all deaths were stored in the office of the head of department of obstetrics and gynaecology as soon as they occurred. Information was extracted from the case files at the end of the year. The total number of deliveries was obtained from the registers kept in labour and isolation wards respectively. RESULTS: There were 45 maternal deaths; 40 (88.9%) among the unbooked and 5 (11%) among the booked mothers constituting a maternal mortality ratio of 23, 121.4 and 339.7 per 100,000 deliveries respectively. The combined mortality ratio was 2735.6 per 100,000 deliveries. Fifteen (37.5%) unbooked primigravidae died of severe pre-eclampsia/eclampsia. A total of 1645 mothers delivered, 1472 (89.5%) were booked while 173 (10.5%) were unbooked with the hospital. CONCLUSION: Severe pre-eclampsia/eclampsia, haemorrhage and sepsis were the major causes of death. The high maternal mortality was common among the unbooked primigravidae who usually present late with pre-eclampsia/eclampsia. More research into the causes and management of pre-eclampsia/eclampsia are needed to reduce the high maternal mortality associated with it. Lack of antenatal care is also a high risk factor for maternal mortality.

Eclampsia↗
PubMedDate not supplied

Analysis of maternal mortality in a tertiary care hospital to determine causes and preventable factors.

BACKGROUND: All pregnant women are at risk of obstetrical complications and most of these occur during labour and delivery that lead to maternal death. In our setup maternal mortality is seriously under estimated. Safe motherhood as a priority for action can not be identified with out properly assessing maternal mortality. The objectives of this study were to determine causes and preventable factors responsible for maternal mortality. METHODS: This study was conducted in Gynaecology 'C' unit of Ayub Teaching Hospital, Abbottabad, from January 2000 to December 2001. Patients were admitted through emergency obstetrics care unit and Gynaecology out patient department. Patients' demographic record including age, parity, education, socio-economic status along with antenatal care record, level of care and distance from hospital were noted. Causative factors leading to maternal death and contribution factors evaluated. All this information was collected from patients' records. RESULTS: Twenty-six maternal deaths were recorded during study period. The major causative factors were haemorrhage 9 (34.6%), eclampsia 8 (30%), sepsis 5 (19.2%), anaesthetic complications 3 (11.5%) and hepatic encephalopathy 1 (3.8%). Maternal mortality ratio was 12.7/1000 live births (26/2040). The age range was between 18-42 years. There were 16 (61.5%) patients in > 30 years age group. Most of them (69%) were grand multiparas (Parity > 5). Education, antenatal booking and socio-economic status were poor. The distance from hospital was between 10 and 100 KM. The level of care available at nearest health facility was estimated, 40% were attended by traditional birth attendants, 33% by lady health visitors, 10% by doctors and to 17% no level of care was available. CONCLUSION: Obstetrical haemorrhage and hypertensive disorders are still major causes of maternal deaths. Most maternal deaths are preventable. The provision of skilled care and timely management of complications can lower maternal mortality in our setup.

Adolescent↗
PubMed1996

Maternal mortality in the main referral hospital in The Gambia, west Africa.

A retrospective analysis of 78 maternal deaths was performed during 1991-1992 to estimate maternal mortality at the maternity unit of the main tertiary level hospital in The Gambia. The non-abortion maternal mortality ratio (MMR) was 736 per 100 000 live births. Among the direct causes, haemorrhage caused most deaths (24%), followed by hypertensive disorders in pregnancy (HDP) (21%). Sepsis was the main cause of death in 15%. Anaemia led among the indirect causes of death (8%) and was a co-factor in 41% of all deaths. Substandard care factors other than medical causes were determined involving health care facilities, staff, drugs and equipment, and patient-related factors. Well known risk factors of low age (< or = 19 years) and nulliparity were highly represented in the maternal death group, and delivery by Caesarean section occurred more than threefold compared to the overall Caesarean section rate. Taking haemorrhage as an example, it is demonstrated that the way diagnoses are grouped significantly affects the statistical elaboration of maternal deaths.

Adolescent↗
PubMed1999

Maternal mortality in Ramathibodi Hospital: a 28-year comparative study.

A comparative review of maternal mortality rates at Ramathibodi Hospital from 1969 through 1996 including 176, 161 live births is presented. The data are divided into two time periods, both of 14 years, for comparison. A significant decrease in direct obstetric deaths secondary to infection and toxemia (P < 0.05). The rate of deaths due to indirect causes in unchanged. Deaths due to malignancies have increased. This study of maternal mortality demonstrates the need for increased contraceptive services, voluntary sterilization, patient education and preconceptional identification of high-risk patients for further reduction of the maternal mortality rate.

Cause of Death↗