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PubMed1998

Trends and causes of maternal mortality in Kazakhstan.

OBJECTIVE: The aim of this study was to determine trends in the rate and causes of maternal mortality in Kazakhstan. METHODS: Maternal deaths occurring between 1960 and 1996 in the 19 oblast (administrative regions) of Kazakhstan were documented and analyzed. RESULTS: After an initial phase of decrease in the period 1960-1980, the level of maternal mortality in Kazakhstan has been stable at 70-80 maternal deaths per 100,000 live births. Maternal deaths due to hypertension and abortion complications have not substantially decreased. Over the last 10 years, illegal abortions have accounted for most Kazakh maternal deaths resulting from abortion complications. CONCLUSION: To reduce the maternal death rate, the Kazakh health authorities and health workers (obstetricians, midwives, health educators) must develop and rapidly implement maternal health and family planning policies.

Abortion, Illegal↗
PubMed1976

[Maternal mortality in Austria from a clinical point of view].

The maternal mortality rate of 22.4 per 100,000 live births in 1973 is the lowest recorded in Austria. The figures for Austria are compared with the data from other European countries with similar health systems. Austria reflects the overall trend of a decreasing maternal mortality rate. 10 cases of maternal death recorded per 16,447 live births in the 2nd Department of Obstetrics, University of Vienna are presented and discussed with respect to the clinical diagnosis and compared with the main causes of maternal death in the national and international literature. As in other countries, haemorrhage in 3 out of the 10 cases ranks first, whilst in Austria generally, toxaemia has been the most common cause of death in recent years. The main cause of the bleeding is undetected rupture of the uterus, which is frequently concealed behind the clinical diagnosis of circulatory failure with cardiac arrest. 2/3 of the observed cases in the present series are considered to have been avoidable. It is recommended that in future every single reported case of maternal death in Austria is analyzed and the cause of death and the degree of avoidability discussed as is done in England.

Austria↗
PubMed1990

Maternal mortality: a report from a university hospital in Ankara.

Maternal mortality was found to be 140 deaths per 100,000 live births in Hacettepe University Hospital. Infection, hemorrhage and cardiac disease were still the leading causes of maternal deaths. It is possible to reduce the maternal mortality due to these largely preventable causes if standards of care and treatment are raised to a higher level throughout the country.

Cause of Death↗
PubMed1995

[The analysis of the causes and changes in maternal mortality in 42 years].

The causes and change of maternal death in this hospital from 1949 to 1990 was analyzed. The average maternal mortality of 42 years was 150.22/10(5) livebirths. The 42 years was divided into four periods which were 1949-1960, 1960-1970, 1971-1980 and 1981-1990. The results showed that the maternal mortality rate lowered from 365.31/10(5) livebirths in first period to 43.67/10(5) livebirths in the 4th period. The difference was markedly significant P < 0.01. The direct obstetric causes of maternal deaths in these periods were 30.00%, 23.81%, 25.00% and 55.56% respectively and increased in the 4th period. Obstetric hemorrhage (55.71%) pregnancy induced hypertension (31.43%) and preperal infection (11.43%) were the three main causes of maternal deaths in direct obstetric causes. Cardiac diseases (40.00%) was the leading cause in indirect causes.

Adult↗
PubMed1993

Maternal mortality in New Zealand.

New Zealand's maternal mortality rate in the triennium 1986-8 was reviewed in comparison with the rates from Australia and the United Kingdom during 1985-7. The New Zealand rate of 9.6 obstetric deaths/100,000 total births was higher than that for the United Kingdom (6.2) and Australia (4.4). Six of 16 deaths in New Zealand during the triennium were caused by sepsis, including five cases of puerperal infection with group A beta-haemolytic streptococci. Careful analysis of maternal deaths in New Zealand remains an important priority to provide audit of the performance of maternity services.

Australia↗
PubMed2000

Aims, options and outcomes in measuring maternal mortality in developing societies.

BACKGROUND: Effective methods for measuring maternal mortality in developing countries are important, particularly in assessing interventions aiming for safer motherhood. Here the performance of different approaches is compared in the same setting. METHODS: Estimates of maternal mortality in a rural Ethiopian community are reported, made by direct observation, a case-control approach, and the sisterhood method. RESULTS: Adjusted estimates of MMR using these methods ranged between 440 and 665 per 100,000 live births. CONCLUSIONS: The advantages and disadvantages of the different approaches are compared, both for operational feasibility and outcome.

Adolescent↗
PubMed2004

WHO systematic review of maternal mortality and morbidity: methodological issues and challenges.

BACKGROUND: Reducing maternal mortality and morbidity are among the key international development goals. A prerequisite for monitoring the progress towards attainment of these goals is accurate assessment of the levels of mortality and morbidity. In order to contribute to mapping the global burden of reproductive ill-health, we are conducting a systematic review of incidence and prevalence of maternal mortality and morbidity. METHODS: We followed the standard methodology for systematic reviews. We prepared a protocol and a form for data extraction that identify key characteristics on study and reporting quality. An extensive search was conducted for the years 1997-2002 including electronic and hand searching. RESULTS: We screened the titles and abstracts of about 65,000 citations identified through 11 electronic databases as well as various other sources. Four thousand six hundred and twenty-six full-text reports were critically appraised and 2443 are included in the review so far. Approximately one third of the studies were conducted in Asia and Africa. The reporting quality was generally low with definitions for conditions and the diagnostic methods often not reported. CONCLUSIONS: There are unique challenges and issues regarding the search, critical appraisal and summarizing epidemiological data in this systematic review of prevalence/incidence studies. More methodological studies and discussion to advance the field will be useful. Considerable efforts including leadership, consensus building and resources are required to improve the standards of monitoring burden of disease.

Adult↗
PubMed1998

[The structure and incidence of the basic causes of maternal mortality].

The author treats by the presented scientific publication the structure and frequency of causes for maternal mortality in particular countries and mainly in Bulgaria. Several structure types of maternal mortality are examined--"extragenital", "hemorrhagic", "septic". It has been proven through a close examination of the work of women's consultation cabinets with regard to maternal mortality that a considerable dependence and regularity is determined due to the insufficient coverage of women from housing complexes (only 24.9% have 6-14 visits). For 1995 dead pregnant women, women in delivery and young mothers in particular regions are 0.1 for 1000 from 73,032 checked-up women. Only in Sofia and Montana region the mortality rate is 0.2 for 1000. For 1996 the mortality rate in the presented regions (see Table N1) for pregnant women, women in delivery and young mothers has increases to 7 (0.2 for 1000).

Bulgaria↗
PubMed2000

Maternal mortality in rural Gambia: levels, causes and contributing factors.

A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths among women aged 15-49 years. Reported here is an estimation of maternal mortality among these 74 deaths based on a survey of reproductive age mortality, which identified 18 maternal deaths by verbal autopsy. Over the same period there were 4245 live births in the study area, giving a maternal mortality ratio of 424 per 100,000 live births. This maternal mortality estimate is substantially lower than estimates made in the 1980s, which ranged from 1005 to 2362 per 100,000 live births, in the same area. A total of 9 of the 18 deaths had a direct obstetric cause--haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1). Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4). Low standards of health care for obstetric referrals, failure to recognize the severity of the problem at the community level, delays in starting the decision-making process to seek health care, lack of transport, and substandard primary health care were identified more than once as probable or possible contributing factors to these maternal deaths.

Adolescent↗
PubMed1994

A community-based nested case-control study of maternal mortality.

OBJECTIVES: Population-based information from Pakistan on maternal mortality is inadequate to define the magnitude of the problem or to contribute information on the distribution of clinical causes and risk factors. A population-based survey was conducted in eight urban squatter settlements of Karachi, Pakistan, to address these key issues. METHODS: Pre-coded questionnaires were administered to the 10,135 households to ascertain deaths of household members in the 5 years preceding the survey (1984-1989). A verbal autopsy questionnaire was administered to the 121 households where a female death between 15 and 49 years of age was reported. RESULTS: The maternal mortality ratio was estimated as 281 per 100,000 livebirths with hemorrhage, eclampsia and puerperal sepsis as the major causes of maternal deaths. Important risk factors identified were maternal employment, paternal unemployment, and poor prior pregnancy history. Women did seek health care but the assistance sought was often inappropriate. CONCLUSION: Intervention programs for improving timely referral and upgrading of hospitals are suggested.

Adolescent↗
PubMed1985

A return to maternal mortality studies: a necessary effort.

This report reviews the experience of the Santa Clara County Maternal Mortality Study Committee, which continued its local activity after the termination of California state-supported study groups in 1970. A study of 36 maternal deaths among approximately 262,000 live births was compiled over a 13-year period, between 1971 and 1983, in a population group representative of much of California. Although based on a small population sample, the results indicate an imperative need for such reviews to improve the quality of clinical care and to develop significant statistical information on the incidence and causes of maternal mortality. The historical development of study committees throughout the United States illustrates the necessity of standardized definitions and uniform methodology among study groups in all states and territories. A nationwide study is proposed to obtain a broad-based, cumulative maternal mortality series, directed toward the eventual elimination of preventable maternal deaths. The current effort by a special interest group in the American College of Obstetricians and Gynecologists is commended for beginning this task.

Adolescent↗
PubMed1990

Cancer-related maternal mortality in Massachusetts, 1954-1985.

Cancer-related maternal mortality is a rare event. We report the first population-based study of this issue using data collected by the Committee on Maternal Welfare of the Massachusetts Medical Society between 1954 and 1985. The incidence of cancer-related maternal mortality during the study period fell from 3.16 to 0 per 100,000 live births. The most common cancer-associated maternal deaths were due to central nervous system tumors and hematological cancers. To determine the effects of pregnancy on cancer mortality, we compared our data with figures from the Connecticut Register of Mortality for Women aged 15-44. In the pregnant group there was a significantly higher incidence of mortality due to central nervous system tumors and a significantly lower incidence of mortality due to breast cancer. The data suggest that pregnancy may not be contraindicated for a woman with a history of breast cancer, but may be contraindicated for a woman with a history of a central nervous system tumor.

Adolescent↗
PubMed1990

Risk factors for maternal mortality in five Kampala hospitals, 1980-1986.

A case-control study assessing risk factors for maternal mortality was carried out in five Kampala hospitals covering a period of seven years (1 January 1980 to 31 December 1986). The major predictors of maternal mortality were the general condition on admission, the mode of delivery and the Apgar score of the newborn. These predictors indicate that women at high risk were those admitted to hospital for delivery in a poor state of health. We believe that the risk of maternal mortality can be reduced through appropriate action by health workers and that there is a need for a more complete view of risk factors for both maternal and perinatal mortality to be obtained through population-based studies rather than only those women who deliver in hospital.

Case-Control Studies↗
PubMed1999

Maternal mortality among the Kassena-Nankana of northern Ghana.

This report presents key findings from a maternal mortality study conducted in the Kassena-Nankana District of northern Ghana in 1997-98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age-specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.

Adolescent↗
PubMed1974

Maternal mortality at Goroka Base Hospital.

Over the ten year period 1964-73, the causes of the high maternal mortality rate (21.6/1000) at the Goroka Base Hospital are reviewed. The leading causes of maternal mortality are sepsis and obstructed labour followed by ruptured uterus and abortion. Although it will be difficult to reduce the maternal mortality, some relevant recommendations are made.

Abortion, Spontaneous↗
PubMedDate not supplied

[Maternal mortality at the Mexican Institute of Social Security (IMSS). Initial results from a reduction intervention strategy].

OBJECTIVE: To analyze the preliminary results of a medical manager intervention to improve the quality of medical care during pregnancy, delivery and puerperium, on the maternal mortality rates in population covered by the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: We selected the 14 administrative delegations of IMSS that showed the highest rates and absolute numbers of maternal deaths in the years 1999 to 2001. Within this group, the manager medical staff developed activities for medical training of family physicians and gynecologists, to improve medical resources, to achieve a better coordination among medical services, to adequate reference of obstetrical complications to higher-level hospitals, and for monitoring of maternal mortality committees operation. The other 23 IMSS administrative delegations were used as controls. RESULTS: Maternal mortality rates fell down from 40.7 to 28.2 per 100,000 live births among the delegations included in the strategy (mean reduction 30.7%). Among the control delegations maternal mortality rate fell down 1.5% only (32.3 to 31.8 per 100,000 live births). A similar phenomenon was observed for the absolute number of maternal deaths, with a reduction of 36.7% and 8.4%, respectively. CONCLUSIONS: The improving intervention was associated with a noticeable reduction in the maternal mortality rate. It is necessary a long-term observation to confirm a cause-effect relationship.

Female↗
PubMed2002

Trends in maternal mortality and assessment of substandard care in a tertiary care hospital.

OBJECTIVE: To assess the trends in maternal mortality and factors affecting substandard care at a tertiary care hospital in a developing country. METHOD: All maternal deaths during a period of 11 years in a tertiary care hospital were studied. Maternal deaths were defined according to ICD-10. The principal cause and category of death, chief contributory factor, nature of care (standard or substandard), relationship to outcome and responsibility for substandard care (if any) were determined. RESULTS: Among the 133 maternal deaths, 92 (69%) were due to direct causes, 38 (29%) were indirect and 3 (2%) were accidental deaths. Genital tract sepsis (26%), hypertension in pregnancy (24%) and obstetric hemorrhage (20%) accounted for over 70% of deaths. In 79% of deaths, the care was substandard and in 73% of deaths substandard care was felt to have influenced the adverse outcome. Overall maternal mortality rate was 98.5 per 100,000 deliveries. An increasing but insignificant (P=0.08) trend in maternal mortality was noted after 1991. CONCLUSIONS: The majority of maternal deaths remain due to preventable and treatable obstetric complications. Maternal death enquiries of this nature facilitate identification of factors contributing to substandard care. It is important to ascertain that life threatening obstetric complications receive high quality emergency obstetric care at all levels.

Adult↗
PubMed1975

[Maternal mortality in cesarean section as compared to vaginal delivery].

Caesarean section-rates of more than 10% in our days are not seldom; the reasons are the changed and enlarged indications for Caesarean section. The increase of the Caesarean section-frequency is parallel to the decrease of maternal mortality. The authors' investigations came to the same results. From 1963-1974 they examined 29534 deliveries (28184 spontaneous deliveries and 1350 Caesarean sections). In the examined years the Caesarean section-frequency increased from 3.6% to 5.7%. The maternal mortality of all deliveries was 5.47% (14 from 29534);the maternal mortality of the spontaneous vaginal deliveries was 0.14% (4 from 28184), in the Caesarean sections the maternal mortality was 7.41% (10 from 1350). The different causes of exitus in Caesarean section are discussed. Even "adjusted statistics" show that maternal mortality in Caesarean section is until today 10 to 15 times as high as in vaginal deliveries. Therefore Caesarean section means a ten times higher risk than a spontaneous delivery. For these reasons Caesarean section should not develop to the delivery's "method of choice" and we should keep our intentions also in future to the vaginal methods of delivery.

Cesarean Section↗