全国孕产妇死亡监测结果分析

对１９８９～１９９１年全国３０省、自治区、直辖市２４７个监测点１．０亿人口范围内的孕产妇死亡监测资料进行分析。监测地区三年内活产总数４２０１４５７例，孕产妇死亡３２７４例，孕产妇监测死亡率平均为８０．０／１０万，调整后为８７．８／１０万。城市、农村、不同地区孕产妇死亡率的高低有明显差异，三年比较，城市、农村孕产妇死亡率呈下降趋势，农村更为明显。孕产妇死亡原因主要为产科出血、好高征、心脏病、产褥感染、羊水栓塞、肝病，产科出血主要原因为胎盘滞留、宫缩乏力。结果显示：可避免的死亡占８９．０％，不可避免的死亡占１１．０％。并对孕产妇死亡的有关问题进行讨论。     

42年孕产妇死亡原因变化分析

回顾性分析我院１９４９～１９９０年间孕产妇死亡原因及其变化，结果：４２年孕产妇总死亡率为１５０．２２／１０万，将４２年分４个阶段（１９４９～１９６０年，１９６１～１９７０年，１９７１～１９８０年，１９８１～１９９０年），死亡差从第一阶段的３６５．３１／１０万下降至第四阶段的４３．６７／１０万，第四阶段与以上阶段死亡率相比，差异有显著性（Ｐ＜０．０１）。死于直接产科原因的构成比在一、第二、第三阶段分     

1996～2000年全国孕产妇死亡率变化趋势分析

目的 了解我国孕产妇死亡率变化趋势、主要死亡原因和变化特征。方法 在全国116个监测点,采用以人群为基础的流行病学调查方法,调查1996-2000年全国孕产妇死亡率、农村与城市孕产妇死亡率差别及主要死亡原因。结果 (1)1996-2000年全国孕产妇死亡率由63．9／10万下降到53.0／10万,下降幅度为17．1％;农村孕产妇死亡率由86．4／10万下降到67．2／10万,下降幅度为22.2％;城市孕产妇死亡率由29.2／10万下降到28．9／10万,下降幅度为1．0％。(2)全国孕产妇主要死亡原因的前3位分别为产科出血、妊娠高血压综合征和羊水栓塞,农村和城市的孕产妇主要死亡原因略有差异。(3)1996-2000年全国和农村的产科出血死亡率分别下降33．8％和34．9％。结论 1996-2000年全国和农村的孕产妇死亡率呈下降趋势,城市孕产妇死亡率出现波动。全国和农村的产科出血死亡率呈下降趋势。     

上海市15年妊娠合并心脏病的临床资料分析

目的：探讨妊娠合并心脏病的变化趋势。方法：对上海市１０所教学医院１９８１～１９９５年住院分娩的妊娠合并心脏病患者的临床资料进行回顾性分析。结果：３７９０６５例分娩中，合并心脏病２６８０例，发病率为０．７１％；死亡１５例，病死率为０．５６％，死亡专率为３．９６／１０万，占孕产妇总死亡数的１２．４０％。将１５年分为１９８１～１９８５年、１９８６～１９９０年、１９９１～１９９５年３个时期观察，心脏病孕妇的死亡率分别占总死亡数的４．４８％、２２．８６％及２１．０５％。先天性心脏病孕妇１３３３例，占４９．７４％；风湿性心脏病孕妇７５９例，占２８．３２％，前者与后者之比为１．７６１，从３个时期的资料来看，二者的比例分别为１．２７１，２．３７１及２．８１１。心功能Ⅰ级与Ⅱ级者共占妊娠合并心脏病患者总数的８５．４５％，发生心力衰竭者为７．６０％。妊娠合并心脏病的围产儿死亡率为７．７６‰。分娩方式常采用剖宫产。结论：妊娠合并心脏病至今仍是孕产妇死亡的主要原因之一。应建立孕前咨询中心，根据其心脏病种类及分型、心功能状况进行评分，以判定该患者能否妊娠。     

部分地区有关孕产妇死亡个体因素和社区因素的多水平分析

目的 分析个体及社区因素对孕产妇死亡的影响，从而制定有效降低孕产妇死亡率的措施。方法 采用在吉林、新疆、湖南、贵州、海南五省１１４个县调查的１９９７年的全部孕产妇死亡的县级加和资料以及相应的县组人口、经济、卫生资源等方面资料，应用多水平分析的方法研究影响我国部分农村地区，特别是贫困、偏远和少数民族地区孕产妇死亡的因素。结果 调查地区孕产妇死亡率很高，平均为１５９．３／１０万。影响孕产妇死亡率的主要     

妊高征与心、脑血管疾病的防治

妊高征与心、脑血管疾病的防治翁霞云妊高征是孕妇常见的并发症，严重地威胁着母婴安全与健康，至今仍为孕产妇死亡的主要原因，据１９８９～１９９１年全国３０省、自治区、直辖市统计孕妇死于妊高征的占７．７／１０万，是我国农村孕母死亡的第二位，占全部死亡的１０％...     

胎儿内监测对妊娠结局的影响及子宫收缩的观察

比较３０例行胎儿内监测产妇（内监测组）和５２例未行胎儿内监测产妇（对照组）的妊娠结局，并对部分病例进行细菌学及胎盘病理学检查。结果发现：内监测组胎儿窘迫发生率为５６．７％（１７／３０），新生儿病率为２３．３％（７／３０），与对照组比较，差异有显著意义。内监测组羊水及新生儿咽部吸出物细菌培养阳性率分别为５０．０％（１１／２２）和４５．５％（１０／２２）。提示：应严格掌握胎儿内监测指征。本研究还比较了     

胎儿及新生儿先天性肿瘤15例临床病理分析

分析胎儿及新生儿先天性肿瘤的一般发生情况,及其对胎儿发育的影响和死亡原因。方法 从临床病理学角度,对１５例先天性肿瘤的临床,尸体检查和病理资料进行回顾性分析。结果 先天生肿瘤在胎儿和新生儿期的发生率为７．７／１０万。占围产儿尸体检查总 ０．７％。畸胎瘤最常见,占４６．７％,其次为血管瘤,占２６．７％。本组中,６０．０％的病例在母亲妊娠期有羊水过多表现;     

阴道超声测量子宫内膜厚度用于内膜病变的鉴别诊断

应用阴道超声测量２８１名妇女的子宫内膜厚度，共４５０次。分为生育期、绝经后无出血及阴道不规则出血三组。生育期组３７例，共测量１８３次，并与血清雌、孕激素水平进行对照。内膜厚度为：卵泡期７．８±２．１ｍｍ，排卵日１０．４±１．９ｍｍ，黄体期１０．４±２．３ｍｍ。绝经后无出血组２００例，共测量２００次，内膜厚度范围为１～５ｍｍ，平均１．４±０．７ｍｍ。阴道不规则出血组４４例，共测量６７次，并与组织学检查结果进行对照。萎缩性内膜６例，厚度２．２±２．０ｍｍ；宫腔积液８例，厚度１４．５±６．１ｍｍ；子宫内膜息肉１２例，内膜厚度１６．７±７．７ｍｍ；子宫内膜增生１０例，内膜厚度１７．４±６．７ｍｍ；子宫内膜癌８例，内膜厚度２４．４±１１．９ｍｍ。绝经后内膜的正常厚度应＜５．０ｍｍ。     

顶体蛋白酶抑制剂KF-950对大鼠精子的影响

本文采用体外杀精实验检查ＫＦ－９５０对大鼠精子活力的影响和明胶底物膜法测定 ＫＦ－９５０对精子顶体蛋白酶活性的抑制作用。结果表明,ＫＦ－９５０与大鼠精液作用 ２０ ｓｅｅ 及 １２０ ｓｅｅ,最低杀精浓度分别为 １． ５６±０． １３ ｍｇ／ｍｌ和 ０． ７３±０． ０７ ｍｇ／ｍｌ,其杀精能力 明显低于壬苯醇醚（Ｐ＜０．０１）;当ＫＦ－９５０浓度为１× １０－１２ｍｇ／ｍｌ时,平均晕轮阳性率 （％）及平均晕轮直径（μｍ）分别为８３．００±７．１０及１８．２７±１．９４（与对照组比较Ｐ＜ ０．０１）,完全抑制浓度为 １×１０－３ｍｇ／ｍｌ。抑制平均晕轮阳性率和平均晕轮直径的半数有效 浓度ＥＤ５０分别为４．１５×１０－７ｍｇ／ｍｌ和２．３４×１０-7 ｍｇ／ｍｌ。本实验证明ＫＦ－９５０对精子顶 体蛋白酶具有高效抑制作用,而杀精子作用较弱,是一种新型的顶体蛋白酶抑制剂。     

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.     

山东省2007~2013年孕产妇死亡率的变化及预测

目的:分析孕产妇死亡率的变化规律,为进一步降低孕产妇死亡率提供参考依据。方法:回顾调查分析2007~2013年山东省孕产妇死亡监测点资料,并进行自回归滑动平均模型死亡率预测。结果:7年孕产妇死亡率依次为20.91/10万、20.85/10万、22.24/10万、21.13/10万、20.59/10万、18.94/10万和16.80/10万,平均为19.53/10万,年平均下降率为3.58%;预测2014年孕产妇死亡率为14.11/10万。前3位死因为产科出血、妊娠合并心脏病、肺栓塞。分娩地点、死亡地点、孕产妇产前检查情况、家庭人均年收入及文化程度对其死亡有影响。评审结果显示,50.82%的死亡孕产妇是可避免的。结论:山东省孕产妇死亡率下降速度减慢,处于平台期。实现孕产妇死亡率进一步降低有赖于提高产科服务能力、提升社会经济水平、提高孕产妇及家属认知与识别能力等综合措施的共同干预。     

An update on maternal mortality in low-resource countries

Maternal mortality constitutes a major problem in the context of women’s health. All regions experienced a decline in maternal mortality ratio (MMR) between 1990 and 2010. Among those women who do not die, 300 million are currently living with health problems and disabilities caused by complications of pregnancy and childbirth. MMR in sub-Saharan Africa remains high, at more than 450 maternal deaths per 100 000 live births. It is currently accepted that in many areas the Millennium Development Goals will not have been achieved by 2015 and in some countries, if current trends continue, they will not be reached until after 2040. Maternal mortality is much more than just a health problem. It involves lack of respect for women’s basic human rights and failure to show the disadvantages and risks to which they are exposed.     

Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria

ObjectiveTo evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.MethodsA retrospective and comparative study of maternal deaths between 2004 and 2010 was carried out. The main outcome measures were yearly maternal mortality ratio (MMR), relative risk (RR) of maternal mortality, and presentation–intervention interval. The yearly MMR and the RR of maternal mortality were compared with the figures from 2004, which represented the pre-SERVICOM era.ResultsThere were 4916 live births and 54 maternal deaths during the study period, giving an MMR of 1098 per 100 000 live births. Pre-eclampsia/eclampsia was the most common direct cause (25.0%), followed by hemorrhage (18.8%) and sepsis (8.3%). Anemia (12.5%) was the most common indirect cause. There was a progressive reduction in MMR and RR of maternal mortality, with a corresponding increase in live births. The presentation–intervention interval improved significantly from 2006.ConclusionA positive change in the attitude of health workers and the elimination of fee-for-service in emergency obstetric care would reduce type 3 delays in public health facilities, and consequently reduce maternal mortality.     

Priorities in emergency obstetric care in Bolivia––maternal mortality and near-miss morbidity in metropolitan La Paz

Objective  To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia.
Design  Facility-based cross-sectional study.
Setting  Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme.
Population  All maternal deaths and women with near-miss morbidity.
Methods  Inclusion of near-miss using clinical and management-based criteria.
Main outcome measures  Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission.
Results  MMR was 187/100 000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables.
Conclusions  Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.     

Evaluation of Obstetric Near Miss and Maternal Deaths in a Tertiary Care Hospital in North India: Shifting Focus from Mortality to Morbidity

Objective

Near miss audit improves understanding of determinants of maternal morbidity and mortality and identifies areas of substandard care. It helps health professionals to revise obstetric policies and practices.

Methods

A retrospective review of obstetric case records was performed to assess frequency ad nature of maternal near miss (MNM) cases as per WHO criteria. For each case, primary obstetric complication leading to maternal morbidity was evaluated. Obstetric complications were analyzed to calculate prevalence ratio, case fatality ratio, and mortality index.

Results

There were 6,357 deliveries, 5,273 live births, 247 maternal deaths, and 633 MNM cases. As per WHO criteria for Near miss, shock, bilirubin >6 mg%, and use of vasoactive drugs were the commonest clinical, laboratory, and management parameters. Hemorrhage and hypertensive disorders of pregnancy were leading cause of MNM (45.7 and 24.2 %) and maternal deaths (28.7 and 21.5 %). Highest prevalence rate, case fatality ratio, and mortality index were found in hemorrhage (0.53), respiratory diseases (0.46), and liver disorders (51.9 %), respectively.

Conclusion

Developing countries carry a high burden of maternal mortality and morbidity which may be attributed to improper management of obstetric emergencies at referring hospitals, poor referral practices, and poor access/utilization of health care services.     

Maternal Health and Survival in Pakistan: Issues and Options

Although its measurement may be difficult, the maternal mortality ratio (MMR) is a key indicator of maternal health globally. In Pakistan each year over five million women become pregnant, and of these 700 000 (15% of all pregnant women) are likely to experience some obstetrical and medical complications. An estimated 30 000 women die each year from pregnancy-related causes, and the most recent estimates indicate that the MMR is 276 per 100 000 births annually. In this review, we describe the status of maternal health and survival in Pakistan and place it in its wider context of key determinants. We draw attention to the economic and social vulnerability of pregnant women, and stress the importance of concomitant broader strategies, including poverty reduction and women’s empowerment. Undernutrition for girls, early marriage, and high fertility rates coupled with unmet needs for contraception are important determinants of maternal ill health in Pakistan. Our review also examines factors influencing the under-utilization of maternal health services among Pakistani women, such as the lack of availability of skilled care providers and poor quality services. Notwithstanding these observations, there are evidence-based interventions available that, if implemented at scale, could make important contributions towards reducing the burden of maternal mortality in Pakistan.     

Maternal mortality rates in the last eight years: A university hospital-based study from Turkey

Objective.?To analyze the cause of changing maternal mortality ratios (MMRs) in a tertiary women's health center in Turkey in the last eight years.

Materials and methods.?Charts of patients seen between 1998 and 2005 were retrospectively reviewed. Statistical analysis was performed using the Chi-square test. The results were accepted to be significant when the p value was <0.05.

Results.?During this period, 27 pregnancy-related deaths were identified via hospital death records. The MMR was found to have decreased in rate by approximately 50% from 822.2/100 000 live births in the previous report including the years 1978–1997 to 412.0/100 000 during the last eight years (p < 0.01). Pregnancy-induced hypertension was still the most frequent cause of maternal death. The decrease in MMR was due to the decrease in the ratio of maternal infection (26.4% in 1978–1997 to 7.4% in 1998–2005, p < 0.01).

Conclusion.?Although treatment in the antenatal care and health service has decreased maternal deaths, it was discovered that the MMR has not reached the optimum levels found in developed countries in the last eight years. Also the percentage of direct obstetric deaths (with the exception of those caused by infection) showed no change and was similar to that found in the previous report (1978–1997).     

Maternal mortality in rural India: a hospital based, 10 year retrospective analysis.

OBJECTIVES: To estimate the maternal mortality ratio (MMR) in Ludhiana, a city of Northern India in order to determine the causes associated with MMR and to suggest ways to reduce it. METHODS: Retrospective analysis of the mortality records of obstetrics cases in Christian Medical College, Ludhiana, India. RESULTS: The mean MMR for the 10 year period was 785 per 100,000 live births. Of the total 116 reported maternal deaths, 44 (41.9%) were due to induced septic abortion. The reasons were unwanted pregnancy in 22 (50%) and 11 (25%) were female feticide. CONCLUSIONS: In our hospital based analysis, MMR was very high. Most maternal deaths are preventable by intervention at the appropriate time and it is important for health professionals, policy makers and politicians to implement the introduction of programs for reducing maternal mortality. Special emphasis should be placed on antenatal care, the establishment of a registration system and measures to abolish illegal abortion.     

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.