National maternal mortality ratio for Jordan, 2007-2008

Objective

To estimate the number of maternal deaths per 100 000 live births during 2007-2008 among Jordanian women; to identify the causes of maternal mortality; and to compare the results with those of the last report for 1995-1996.

Methods

Reproductive-age mortality study of maternal deaths among women aged 15-49 years in Jordan in 2007-2008.

Results

Among 1406 identified deaths of reproductive-aged women, 76 maternal deaths were identified out of 397 588 live births, for a maternal mortality ratio of 19.1 deaths per 100 000 live births. Forty-three (56.6%) deaths were attributable to hemorrhage, thrombosis and thromboembolism, and sepsis. Avoidable factors were present in 53.9% of women, 52.6% had substandard care, and 31.5% had 3 or fewer antenatal visits. Of those with available information on family planning, only 29.4% had ever used any form of contraception.

Conclusions

Maternal deaths in Jordan are declining. The maternal mortality ratio of 19.1 deaths per 100 000 live births reported for 2007-2008 showed a remarkable reduction of 53.9% achieved in the 12 years since the 1995-1996 report (a 4.5% annual reduction), which is approaching the 75% reduction recommended by Millennium Development Goal 5.     

Registering in a health facility for delivery protects against maternal mortality in a developing country setting.

A prospective study on the maternal deaths in public and private health facilities in Ogun State was undertaken for a period of 9 months (November 2003 - July 2004). While data were collected from all of the primary, the secondary and tertiary health facilities, it could only be collected from 123 (18.6%) of the private health facilities in the state. Of the 20,831 live births during the period, 37 maternal deaths occurred giving a maternal mortality ratio of 177.6 deaths per 100,000 live births. Some 84% of maternal deaths were not registered for delivery in the health facilities they delivered. The maternal mortality ratio is comparable with previously reported data for South-West Nigeria. A total of 81% of the deaths were due to three main causes: haemorrhage, eclampsia and infection. The maternal mortality ratio was almost three-fold greater in women above the age of 35 years. There is therefore a need to enhance activities to reduce maternal mortality. Private health facilities registration must be tied to sending data to authorized government departments. There is also a need to capture childbirth and attendant complications and death occurring outside orthodox health facilities.     

上海市20年剖宫产产妇死亡原因分析

目的 了解剖宫产产妇死亡原因及剖宫产潜在危险性，以降低剖宫产产妇死亡率。方法 对上海市１９７８～１９９７年间剖宫产产妇死亡病例资料进行回顾性分析。结果 （１）１９７８～１９８７年的剖宫产率为１５．５５％（２５８１５８／１６５９８９２），显著低于１９８８～１９９７年的２９．３９％（３６５３７６／１２４３３３７），两者比较，差异有极显著性（Ｐ〈０．０１）。（２）２０年间产妇死亡４３０例，其中剖宫产产妇     

Maternal mortality among Palestinian women in the West Bank.

OBJECTIVE: To assess maternal mortality and determine the most common causes of maternal death among Palestinian women. METHODS: Available data on the 431 women who died between the ages of 15 and 49 years in the West Bank in 2000 and 2001 were reviewed. The data were collected from official agencies and, using the verbal autopsy approach, interviews of the deceased women's relatives. The interviews were conducted in all 10 districts of the West Bank over 30 months. RESULTS: Maternal mortality ratios for 2000 and 2001 were 29.2 and 36.5 per 100,000 live births, respectively. Cardiovascular diseases and hemorrhage were the most common causes of death. Misclassification was found in 38% of the deaths. A tentative analysis of avoidability indicated that 69% of maternal deaths could be classified as avoidable. CONCLUSION: A majority of the maternal deaths identified were avoidable. Substandard classification of maternal deaths is hampering efforts to reduce maternal mortality.     

上海市2000-2009年孕产妇死亡情况分析

目的 通过对上海市孕产妇死亡资料的分析,了解孕产妇系统管理中的问题,为提出有效的干预措施降低孕产妇死亡率提供科学依据.方法 采用回顾性分析的方法,对上海市2000至2009年孕产妇死亡病例资料及评审结果、WHO十二格表分类进行分析.结果 (1)活产数变化:上海市活产总数从2000年的84 898例上升到2009年的187 335例,10年增加了120.7%.其中外地户籍来上海分娩者近10年有大幅度增长,已从2000年的26.5%上升到2009年的54.8%,期间增长了4.6倍.(2)孕产妇死亡率及其构成比:2000至2009年上海市活产数共1 279 010例,其中孕产妇死亡262例,死亡率为20.48/10万(262/1 279 010).上海市户籍者死亡率为8.09/10万(55/680 005);外地户籍者死亡率为34.56/10万(207/599 005).(3)不同广籍死亡率变化趋势:从2000年的21.2/10万降至2009年的9.61/10万.上海市户籍者孕产妇死亡率除2003至2004年外基本稳定在10.00/10万以下;外地户籍者孕产妇死亡率下降明显,2002年高达77.42/10万,而到了2009年已下降到11.69/10万.(4)孕产妇死因构成比及顺位:262例孕产妇死亡前5位的死因顺位依次为产科出血(69例,26.3%)、妊娠期高血压疾病(27例,10.3%)、妊娠合并心脏疾病(24例,9.2%)、妊娠合并肝脏疾病(17例,6.5%)、羊水栓塞和异位妊娠(均为15例,5.7%).(5)2000至2009年前后两个5年孕产妇主要死因变化:上海市户籍者的异位妊娠、妊娠期高血压疾病和妊娠合并心脏疾病的死因变化较大,其中异位妊娠死亡率从第一个5年的1.36/10万下降到第二个5年的0.26/10万;妊娠合并心脏疾病从第一个5年的1.36/10万下降到第二个5年的0.52/10万;妊娠期高血压疾病从第一个5年的0上升到第二个5年的0.78/10万.外地户籍者孕产妇的产科出血、异位妊娠、妊娠期高血压疾病死亡率下降显著,作为首位死因的产科出血从第一个5年的21.85/10万下降到第二个5年的5.47/10万;异位妊娠从第一个5年的4.37/10万下降到第二个5年的0.68/10万;而妊娠期高血压疾病从第一个5年的6.87/10万下降到第二个5年的2.96/10万.(6)直接产科原因与间接产科原因的死亡:262例死亡孕产妇中,直接产科原因导致的死亡141例(53.8%);而间接产科原因导致的死亡121例(46.2%).(7)产科出血死亡率的变化:2000至2009年的10年间,上海市孕产妇产科出血死亡率呈逐年下降趋势,从2000年的10.6/10万下降至2009年的1.7/10万.(8)孕产妇死亡病例的评审结果:262例死亡孕产妇经上海市级专家评审后结果分为3类,Ⅰ类(可避免死亡)41例(15.6%),Ⅱ类(创造条件可以避免死亡)66例(25.2%),Ⅲ类(不可避免死亡)155例(59.2%).55例上海市户籍死亡孕产妇中,Ⅰ类17例(30.9%),Ⅱ类14例(25.5%),Ⅲ类24例(43.6%);207例外地户籍死亡孕产妇中,Ⅰ类24例(11.6%),Ⅱ类52例(25.1%),Ⅲ类131例(63.3%).(9)WHO十二格表分类:从死亡孕产妇的知识技能、态度、资源和管理方面分析上海市户籍和外地户籍孕产妇死亡原因的影响因素显示,上海市户籍死亡者中以医疗保健机构的知识技能问题占主要原因(80.0%);外地户籍死亡者中以个人家庭的知识技能和态度为主要原因,分别为54.1%和40.1%.结论 (1)近10年上海市孕产妇死亡率(尤其是外地户籍孕产妇死亡率)逐年显著下降,结果提示上海市对孕产妇的系统管理措施有效.(2)产科出血虽然跃居10年孕产妇死因的首位,但呈显著下降的趋势;30%～40%的孕产妇死亡可创造条件加以避免.(3)但随着孕产妇死因构成比的变化及服务需求的提高,探索新的服务与管理模式以保障母婴安康更显得十分必要.

Abstract：

Objectives To find problems in the systematic management of maternal health and to provide evidence for developing effective interventions to reduce maternal mortality in Shanghai. Methods Every maternal death from 2000 to 2009 was audited by experts and relevant informations were collected and analyzed retrospectively. Results ( 1 ) Number of live births. The number of live births in Shanghai rised from 84 898 in 2000 to 187 335 in 2009, which increased by 120. 7%. Notably, the number of live births of migrating people increased 4. 6 times. In 2000, it took up 25.5% and in 2009, it rose to 54. 8%. ( 2 )Maternal mortality ratio (MMR) and its composition. The total live births from 2000 to 2009 was 1 279 010,among which there were 262 maternal deaths, with average maternal mortality of 20. 48 per 100 000 live birth (262/1 279 010). For Shanghai residents, the MMR was 8.09 per 100 000 live births (55/680 005 ),while the MMR of migrating people was 34. 56 per 100 000 live births ( 207/599 005 ). ( 3 ) Trends of MMR. The MMR declined from 21.2 per 100 000 live births in 2000 to 9.61 per 100 000 live births in 2009. The MMR of Shanghai residents maintained below 10 per 100 000 live births with exception of year 2003 and 2004. The MMR of migrating people declined sharply. In 2002 it was 77.42 per 100 000 live births, and in 2009 it decreased to 11. 69 per 100 000 live births. (4)The composition of causes of maternal deaths and rank order. The top 5 causes of deaths were obstetric hemorrhage (69 cases, 26. 3% of the total deaths), pregnancy induced hypertension (27 cases, 10. 3% of the total deaths), heart diseases (24 cases,9. 2% of the total deaths), liver diseases ( 17 cases, 6. 5% of the total deaths), amniotic fluid embolism and ectopic pregnancy ( 15 cases respectively, 5.7% of the total deaths). ( 5 ) The changes of causes between the first 5 years and the latter 5 years. The MMR of ectopic pregnancy, heart diseases and pregnancy induced hypertension changed significantly in Shanghai residents. The MMR of ectopic pregnancy decreased from 1.36 per 100 000 live births in the first 5 years to 0. 26 per 100 000 live births in the latter 5 years. The MMR of heart diseases decreased from 1.36 per 100 000 live births to 0. 52 per 100 000 live births. While the MMR of pregnancy induced hypertension increased from 0 to 0. 78 per 100 000 live births. For migrating population, the MMR of obstetric hemorrhage, ectopic pregnancy and pregnancy induced pregnancy deceased significantly. As the primary cause, the MMR of obstetric hemorrhage deceased from 21.85 per 100 000 live births in the first 5 years to 5.47 per 100 000 live births in the second 5 years. The MMR of ectopic pregnancy decreased from 4. 37 per 100 000 live births to 0. 68 per 100 000 live births. And the MMR of pregnancy induced hypertension decreased from 6. 87 per 100 000 live births to 2. 96 per 100 000 live births.(6) Direct obstetric causes and indirect obstetric causes of maternal deaths. Among the 262 deaths,141 cases (53. 8% ) were due to Direct obstetric causes and 121 (46. 2% ) were due to indirect obstetric causes. (7)The trend of MMR of obstetric hemorrhage. The MMR of obstetric hemorrhage declined from 10. 6 per 100 000 live births in 2000 to 1.7 per 100 000 live births in 2009. ( 8 ) The results of maternal death audit. The results of maternal death audit were classified into 3 categories: 41 cases ( 15.6% )belonged to the first category, i. e, avoidable deaths; 66 cases (25.2%) belonged to the second category,i. e, avoidable when creating some conditions; and 155 cases (59. 2% ) belonged to the third category,which means not avoidable. Among 55 deaths of Shanghai residents, 17 cases (30. 9% ) belonged to the first category, 14 cases (25.5%) belonged to the second, and 24 cases (43.6%) belonged to the third category. Among 207 deaths of migrating population, 24 cases (11.6%) belonged to the first category,52 cases (25. 1% ) belonged to the second, and 131 cases (63.3%) belonged to the third category. (9)WHO twelve-grid classification of maternal deaths. The factors, including attitude, knowledge and skills, resources and management of the dead people and their families, the medical institutes and social supportive departments were integrated and analyzed. It showed that the main reason of maternal deaths of Shanghai residents was poor knowledge and skills of medical staffs, accounting for 80. 0% of the deaths. While the main reasons of maternal deaths of migrating people were poor knowledge and skills, inappropriate attitude of the dead people and their families, which took up 54. 1% and 40. 1% respectively. Conclusions The MMR in Shanghai declined continuously from 2000 to 2009, especially for migrating population which reflected the interventions of maternal management in Shanghai were effective. Though obstetric hemorrhage was the first top cause of maternal death during past 10 years, it declined Sharply. 30% to 40% maternal deaths were avoidable if some conditions were created. However, in order to adapt the changes of main causes of maternal deaths and accomplish increasing service requirements, it is necessary to develop new service and management mode.     

Place of birth or place of death: An evaluation of 1139 maternal deaths in Nigeria

Objective

to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria.

Design

a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method.

Setting

Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural).

Participants

3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies.

Findings

1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25–34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ²=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital.

Key conclusions

maternal mortality in Nigeria is still unacceptably high.

Implications for practice

ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills.     

Estimating maternal mortality and causes in South Africa: National and provincial levels

Objectives

maternal mortality estimates for South Africa have methodological weaknesses. This study uses the Growth Balance Method to adjust reported household female deaths and pregnancy-related deaths and the relational Gompertz model to adjust reported number of live births and estimate maternal mortality in South Africa at national and provincial level; examines the potential impact of HIV/AIDS prevalence; and investigates the recorded direct causes of maternal mortality.

Design

data from the 2001 Census, 2007 Community Survey and death registrations were utilised. Information on household deaths, including pregnancy-related deaths was collected from the aforementioned census and survey.

Setting

enumerated households in the 2001 Census and a nationally representative sample of 250,348 households in the 2007 Community Survey.

Participants

information about members of households who died in the preceding 12 months was collected, and of these deaths whether there were women aged 15–49 who died while pregnant or within 42 days after childbirth.

Findings

maternal mortality ratio of 764 per 100,000 live births in 2007, ranging from 102 per 100,000 live births in the Western Cape province to 1639 in the Eastern Cape. Maternal infections and parasitic diseases as well as other maternal diseases complicating pregnancy, childbirth and the puerperium are the major causes. The study found a weak correlation between provincial HIVprevalence and maternal mortality ratio.

Conclusion

despite strategies to improve maternal and child health, maternal mortality remains high in South Africa and it is unlikely that the Millennnium Developmemnt Goal of reducing maternal will be achieved.     

Maternal mortality at twelve teaching hospitals in Indonesia-an epidemiologic analysis

Records on 36,062 maternity cases admitted to 12 teaching hospitals throughout Indonesia between 1977 and 1980 were analyzed. A hospital maternal mortality rate of 37.4/10,000 cases (39.0/10,000 live births) was derived that was about ten times higher than rates reported from developed countries in the early seventies. Hemorrhage, infection and toxemia accounted for 91.2% of deaths resulting from direct obstetric causes and for 86,1% of total deaths. It is postulated that if all pregnant women received adequate antenatal care, and if all women wanting no additional children were sterilized, maternal mortality would be cut in half. It is recommended that maternal health services in Indonesia be integrated into its successful family planning program.     

A study of maternal mortality in 8 principal hospitals in Pakistan in 2009

Objectives

To determine maternal mortality to assess the achievement of Millennium Development Goal 5 in Pakistan and suggest remedial measures.

Methods

Throughout 2009, maternal deaths occurring in obstetrics and gynecology departments in 8 hospitals in Rawalpindi and Islamabad, Pakistan, were recorded. A data form was filled in by the duty registrar at the time of death. Data were analyzed via SPSS.

Results

During the study period, there were 47 209 live births and 108 maternal deaths (age 17-45 years). Among those who died, 30% were primigravidas, 50% had a parity of 1-4, and 20% had a parity of 5 or more; 20.4% had not delivered, 40.7% had vaginal delivery, and 36.1% had cesarean delivery; 67.6% were unbooked and 32.4% were booked (14 under care of a consultant and 21 under care of a medical officer); 73%, 22%, and 5% died in the first, second, and third trimesters, respectively; 17.5% died prenatally, 4.6% during labor, and 78% postpartum; 73% were in a critical condition and 8% were dead on arrival. Eclampsia, postpartum hemorrhage, and sepsis caused 23, 13, and 13 deaths, respectively.

Conclusion

Maternal death can be effectively managed by skilled care during pregnancy, childbirth, and the postnatal period.     

Maternal deaths: initial report of an on-going monitoring of maternal deaths at the Federal Medical Centre Katsina,Northwest Nigeria

Abstract

Objectives: To assess the maternal mortality ratio (MMR) from data collected as maternal deaths occurred over a 4-year period.

Methods: A Departmental database established in 2008 was used to keep data on deliveries and maternal deaths as they occurred. The causes of death were decided after a meeting reviewed the case. Analysis was done using Microsoft Excel software and results presented in means and frequencies.

Results: Eight thousand two hundred and twenty live deliveries that occurred were complicated by 68 maternal deaths. The MMR was 827/100?000 live births. The MMR for unbooked women was four times higher than for booked women. Obstetric haemorrhage was the main (21.6%) direct cause of death followed by preeclampsia/eclampsia (18.9%). While anaemia was the leading (8.1%) indirect cause of death, tetanus in the puerperium reared its head as an emerging (5.4%) indirect cause of maternal death. None of the women ever used contraceptives. Most deaths occurred in teenage mothers (23.5%), unbooked women (86%) and in the postpartum period (69%).

Conclusion: The MMR was high and tetanus in puerperium emerged as an indirect cause of maternal deaths. There is a need to curb the emergence of tetanus in the puerperium as a cause of maternal death.     

A ten-year retrospective review of maternal cardiac arrest: Incidence,characteristics, causes,and outcomes in a tertiary-care hospital in a developing country

ObjectiveMaternal cardiac arrest is rare. We retrospectively reviewed and reported (1) the incidence of maternal cardiac arrests during admissions for delivery; (2) the characteristics and causes of cardiac arrest; and (3) the mortality rate and outcomes in a referral, single-university, teaching hospital in Thailand.Materials and methodsData on 23 cardiac arrests during admissions for delivery in the decade January 2006–December 2015 were retrospectively chart-reviewed. Patients with gestational ages under 24 weeks or cardiac arrests and death occurring before hospital arrival were excluded. The clinical characteristics of the arrests and outcomes were collected.ResultsOf 89,368 deliveries during the decade, 23 women suffered cardiac arrest (incidence, 1:3885), with 3 of those arrests occurring before delivery (incidence, 1:29,789). One patient underwent a perimortem cesarean delivery in the operating theatre. The most common reasons for the arrests were hypertension during pregnancy and cardiovascular causes (30.4% and 21.7%, respectively). Amniotic fluid embolisms were suspected for 2 patients (8.7%) with unidentified causes. The incidence of maternal deaths in peripartum cardiac arrests was 20/23, representing 86.9% (95% CI, 67.9–95.5) or 1:4468 of deliveries. Three patients suffering cardiac arrests after delivery survived to discharge.ConclusionsWe found a high maternal mortality rate following cardiac arrests during hospitalization for delivery. To decrease the incidence of arrests during the peripartum period and diminish the maternal mortality rate, identification of the causes and precipitating factors is vital. High-risk pregnant women require multidisciplinary care to improve the survival-to-discharge rate.     

Premature death among teenage mothers

OBJECTIVE: Some data suggest an association between teenage childbearing and premature death. Whether this possible increase in risk is associated with social circumstances before or after childbirth is not known. We studied premature death in relation to age at first birth, social background and social situation after first birth. DESIGN: Population-based cohort study. SETTING: Women born in Sweden registered in the 1985 Swedish Population Census. POPULATION: Swedish women born 1950-1964 who had their first infant before the age of 30 years (N= 460,434). METHODS: Information on the women's social background and social situation after first birth was obtained from Population Censuses. The women were followed up with regard to cause of death from December 1, 1990 to December 31, 1995. Mortality rate ratios and 95% confidence intervals (CI) were calculated. MAIN OUTCOME MEASURES: Mortality rates by cause of death. RESULTS: Independent of socio-economic background, teenage mothers faced an increased risk of premature death later in life compared with older mothers (rate ratio 1.6, 95% CI 1.4-1.9). The increased risk was most evident for deaths from cervical cancer, lung cancer, ischaemic heart disease, suicide, inflicted violence and alcohol-related diseases. Some, but not all, of these increases in risk were associated with the poorer social position of teenagers mothers. CONCLUSIONS: Teenage mothers, independent of socio-economic background, face an increased risk of premature death. Strategies to reduce teenage childbearing are likely to contribute to improved maternal and infant health.     

Maternal Mortality and Its Causes in a Tertiary Center

Objectives

To study the maternal mortality and the complications leading to maternal death.

Methods

A retrospective study of hospital records and death summaries of all maternal deaths over the period from January 2000 to August 2009 was carried out.

Results

There were a total of 80 maternal deaths out of 88,443 live births giving maternal mortality rate (MMR) of 90.45 per 100,000 live births. Unbooked and late referral accounted for 77.5 % of maternal deaths. The majority of the deaths was in 30–40-year age group and around term. Hemorrhage was the commonest cause of death (52.5 %), followed by sepsis (13.75 %) and pregnancy-induced hypertension including eclampsia (10 %).

Conclusions

Hemorrhage, sepsis, and pregnancy-induced hypertension including eclampsia were found to be the direct major causes of death. Anemia and cardiac disease were other indirect causes of deaths.     

Estimation of maternal and neonatal mortality at the subnational level in Liberia

Objective

To establish representative local-area baseline estimates of maternal and neonatal mortality using a novel adjusted sisterhood method.

Methods

The status of maternal and neonatal health in Bomi County, Liberia, was investigated in June 2013 using a population-based survey (n = 1985). The standard direct sisterhood method was modified to account for place and time of maternal death to enable calculation of subnational estimates.

Results

The modified method of measuring maternal mortality successfully enabled the calculation of area-specific estimates. Of 71 reported deaths of sisters, 18 (25.4%) were due to pregnancy-related causes and had occurred in the past 3 years in Bomi County. The estimated maternal mortality ratio was 890 maternal deaths for every 100 000 live births (95% CI, 497–1301]. The neonatal mortality rate was estimated to be 47 deaths for every 1000 live births (95% CI, 42–52). In total, 322 (16.9%) of 1900 women with accurate age data reported having had a stillbirth.

Conclusion

The modified direct sisterhood method may be useful to other countries seeking a more regionally nuanced understanding of areas in which neonatal and maternal mortality levels still need to be reduced to meet Millennium Development Goals.     

Maternal mortality in Indonesia and Egypt

Twenty-three percent of deaths to women of reproductive age (15-49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100,000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two-thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children--the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.     

Maternal mortality in Australia, 1973-1996

AIMS: Maternal mortality has declined dramatically over the past 30 years in developed countries. This retrospective study aims to provide an epidemiological overview of maternal deaths in Australia between 1973 and 1996. METHODS: Data were abstracted from national maternal mortality data collection and triennial reports for the period 1973-1996 for women who died from pregnancy-related causes while pregnant or within 42 days of a pregnancy being delivered or terminated. Deaths were restricted to those classified as direct or indirect maternal deaths. Maternal mortality age-specific mortality ratios were calculated. The leading causes of death were examined. RESULTS: Of the 584 deaths, 363 were direct and 221 indirect. The leading causes of direct death were pulmonary embolism (18.4%) and hypertensive disorders (16.3%). Cardiovascular disease accounted for 41% of indirect deaths. The maternal mortality ratio declined from 12.7 deaths per 100,000 confinements in 1973-1975 to 6.2 in 1991-1993, and was 10.0 for the entire 24-year period. For women aged 40-44 years the ratio declined from 165.1 to 14.2 between 1973 and 1996. The ratio for Indigenous mothers was three times higher than for non-Indigenous mothers, being 34.8 in the most recent triennium 1994-1996. CONCLUSIONS: Although maternal deaths are rare in Australia, apparent health inequality persists with Indigenous mothers continuing to have a higher risk of maternal death. While mortality in traditionally higher risk women aged > 40 years has declined, women with morbid cardiovascular disease continue to be over-represented in the deaths. The comparatively high rate of deaths from pulmonary embolism needs to be addressed.     

Trends in maternal mortality in resident vs. migrant women in Shanghai, China, 2000-2009: a register-based analysis

Although Shanghai has good maternal health indicators, it also has a large in-migrating population, which has made control of maternal mortality a major challenge. This study analyzed maternal mortality and causes of death in pregnant women in Shanghai in the ten years from 2000 to 2009, comparing resident and migrant women. All live births were registered and every maternal death audited. The number of live births rose from 84,898 in 2000 to 187,335 in 2009. The number of migrants increased 4.6 times, while the proportion of live births to migrant women increased from 27% to 55%. There were 262 maternal deaths, 55 in Shanghai residents and 207 in migrant women (78.9% of the total). Most deaths in migrant women were due to illegal delivery. Three policy changes focusing on maternal health greatly reduced deaths: low-cost delivery services were established for migrant women in maternity hospitals, five obstetric emergency care and referral centres were created in general hospitals, and training for health professionals and health education for women were instituted. Maternal mortality in Shanghai decreased steadily from 2000 to 2009, reaching 10 per 100,000 live births in 2009. Among Shanghai permanent residents the ratio was below ten in most of those years, while among migrant women it declined sharply from 58 to 12 per 100,000 live births.     

Maternal mortality in the United States, 1979-1986

To understand better the epidemiology and to describe the causes of maternal death, we reviewed all identified maternal deaths in the United States and Puerto Rico for 1979-1986. The overall maternal mortality ratio for the period was 9.1 deaths per 100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death after a live birth. Unmarried women had a higher risk of death than married women. The risk of death increased with increasing live-birth order, except for primiparas. In order to develop strategies to reduce the risk of maternal death in the United States, future studies should include expanded information about each death, which will allow better understanding of factors associated with maternal mortality.     

Trends in maternal mortality over 29 years in a Kuwait Tertiary Teaching Hospital: signs of progress?

This study aims at (1) Assessing trends in maternal mortality in kuwait (2) Define strategies for prevention. Methods: Retrospective analysis of maternal deaths that occurred among, 55,979 live births at a tertiary hospital, between 1980 and 2009. Results: There were 14 maternal deaths, and 55,979 live births, giving a maternal mortality rate of 25 per 100,000 live birth. In terms of decades maternal mortality declined from 54.8 in 1980–90 to 28.4 in 1990–2000 and continued to decline to 12.2 in 2000–2009. Thromboembolism (28.6%), Obstetric haemorrhage (21.5%) and Eclampsia (14.3%) were the leading causes of direct deaths. Cardiac disease is the most common cause of indirect deaths (14.3%) followed by H1N1 pneumonia 7.1%. Eclampsia contributed to 40% of deaths, only in the 1980s. Thromboembolism caused 28.6% of deaths, 50% of which were in the last 9 years. Indirect deaths from cardiomyopathies (66.7%) gained prominence in the 1990s. No deaths from puerperal sepsis were reported after the 1980s (14.3%). Conclusions: Maternal mortality rates are decreasing significantly (p?<?0.01) at our institution over the last 29 years. Obstetric haemorrhage and thromboembolism remain important causes of maternal mortality. Substandard care was identified in 70% of Direct and 55% of indirect deaths.     

Obstetric deaths in Bangladesh, 1996-1997.

OBJECTIVES: The purpose of this study was to measure and to describe obstetric deaths in Bangladesh. METHODS: We reviewed hospital records and interviewed health workers in clinic sites and field workers who cared for pregnant women. RESULTS: We obtained case reports of 28998 deaths of women aged 10-50, of which 8562 (29.5%) were maternal deaths. Most (7086, 82.8%) of these deaths were due to obstetric causes. The most common causes of direct obstetric death were eclampsia (34.3%), hemorrhage (27.9%), and obstructed and/or prolonged labor (11.3%). National direct obstetric death rate was estimated to be 16.9 per 100,000 women. CONCLUSIONS: Efforts to reduce fertility in Bangladesh have led to an estimated 49% reduction in the maternal mortality rate per 1000 women during the past 18 years. Variations in maternal mortality suggest the need to develop local strategies to improve obstetric care.