Maternal deaths in an urban perinatal network, 1992-1998

OBJECTIVE: The object of this study was to use an in-depth peer-review process to determine the maternal mortality ratio at a single urban perinatal center and to identify factors associated with fatal outcomes to elucidate opportunities for preventive measures to reduce the maternal mortality ratio. STUDY DESIGN: Between 1992 and 1998 all maternal deaths occurring within our perinatal network were identified. A peer-review committee was established to review all available data for each death to determine the underlying cause of death, whether it was related to pregnancy, and whether the death was potentially preventable. RESULTS: There were 131,500 births and 42 maternal deaths, for a maternal mortality ratio of 31.9 maternal deaths per 100,000 live births. The adjusted pregnancy-related maternal mortality ratio was 22.8 maternal deaths per 100,000 live births, with 37% of those deaths (11/30) deemed potentially preventable and a provider factor cited in >80% of these. Pulmonary embolus and cardiac disease together accounted for 40% of the pregnancy-related deaths. CONCLUSION: Local maternal mortality ratios identified through a peer-review process indicate that the magnitude of the problem is much greater than is recognized through national death certificate data. The high proportion of potentially preventable maternal deaths indicates the need for improvement in both patient and provider education if we are to reduce the maternal mortality ratio to 3.3 maternal deaths per 100,000 live births, the stated national health goal of Healthy People 2000.     

Antenatal, neonatal and post neonatal deaths evaluated by medical audit. A population-based study in northern Norway - 1976 to 1997

BACKGROUND: Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. SUBJECTS AND METHODS: Antenatal, neonatal and post neonatal deaths (n=472) at > or = 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. RESULTS: The death rate (all deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms > or = 24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3%o of total births), avoidable deaths (13.1% of deaths, 1.3% of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6% of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. CONCLUSION: The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.     

Maternal mortality in West Africa. Rates, causes and substandard care from a prospective survey

BACKGROUND: According to estimates of maternal mortality rates from WHO/UNICEF, the West African rates appear to be among the world's highest. The precision of these estimates from general mortality models is far from ideal and no information on the distribution of causes of death is provided. The principal objective of our study is to describe the maternal mortality, estimation of the rates and distribution of obstetric causes, from a population based survey of pregnant women carried out in West Africa. We also present the main characteristics of the deaths that occurred, including avoidable aspects. METHODS: The survey included all the pregnant women living in seven defined areas, from December 1994 through June 1996, depending on the area. Twenty thousand three hundred and twenty-six pregnant women (94.3% of all those identified) agreed to participate and 19,545 were followed throughout the second trimester of pregnancy, delivery and the puerperium. Physicians from the survey team made special enquiries about all maternal deaths. But the deaths occurring during the first months of pregnancy could not be estimated. A subcommittee analyzed all the deaths, assigned the underlying cause and discussed the avoidable aspects of the death. RESULTS: Sixty-six deaths were reported. Fifty-five (three late) were deaths due to obstetric causes; six were fortuitous deaths, and no cause could be defined for five. As a mean and for pregnancy after week 25, the maternal mortality rate was estimated at 311 (95% CI 234-404) per 100,000 live births and 852 (95% CI 456-1457) in rural areas. Hemorrhages accounted for 29% of obstetric deaths, uterine rupture 13%, eclampsia and infectious diseases 11% each. Seventy-four percent of the direct obstetric causes were considered avoidable. CONCLUSION: Confidential enquiries into maternal deaths in West Africa are not just a concern of the others. They are urgently requested to promote the improvement of health services.     

Maternal mortality audit in a Zimbabwean province

Summary A maternal mortality audit was introduced in the Midlands Province (Zimbabwe) in order to identify which avoidable factors were involved most frequently. During the two-year study period, the maternal mortality rate was 137 per 100,000 total births. The main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%. Access to the health facilities and transport problems only played a minor role.     

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.     

Perinatal mortality in rural Tanzania

Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).     

Maternal deaths in Sweden, 1971-1980

Sixty-eight deaths during pregnancy, parturition and puerperium were recorded in Sweden during the years 1971-80, giving a maternal mortality of 6.6 per 100,000 live births. The figures for abdominal delivery and vaginal were 45.0 and 2.5 per 100,000 live births respectively. Amniotic fluid embolism, pulmonary embolism and hemorrhage were the main causes of death within 24 hours after delivery, while pre-eclampsia/eclampsia and sepsis were predominant during the rest of the puerperium. Age and parity are highly important risk factors. Presumed avoidable factors were identified in 19% of the cases. 9% of the deaths were related to unwanted pregnancy.     

Deaths among women of reproductive age in Cape Verde: causes and avoidability

SUBJECT: In 1992-93 all deaths (n=97) of women 15 to 49 years old in three islands of Cape Verde were investigated to determine the cause of death, the maternal mortality ratio, the reliability of cause-of-death ascertainment, and the level of avoidability. METHOD: Data were obtained through interviews with the deceased person's family members and other knowledgeable persons (verbal autopsy) and through hospital files. RESULTS: The overall mortality rate was 163 per 100,000 women 1549 years old, and the maternal mortality ratio was 127 per 100,000 live births. A plausible diagnosis could be determined in 77%. The most frequent causes of death were circulatory disorders, external causes, maternal causes, infectious diseases. and neoplasms. CONCLUSIONS: It was estimated that three of four of the deaths were avoidable with locally available resources. Since access to health care in the study area is not a major hindrance, a further decrease of female mortality depends mainly on improved quality of care in health facilities.     

Perinatal mortality in rural Tanzania

Summary. Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent pro longed labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).     

Maternal mortality in the U.S. Department of Defense, 1993-1998

OBJECTIVE: To determine the maternal mortality ratio (MMR) in Department of Defense medical facilities from 1993 to 1998. STUDY DESIGN: We conducted a retrospective review of birth data from military medical facilities using the Standard Inpatient Data Records from 1993 through 1998. The total number of live births and dispositions due to maternal death were obtained. RESULTS: Twenty-two maternal deaths occurred in the study time out of 398,107 live births, for an MMR of 5.5 per 100,000 live births. The ratiosfor the service branches were: Army 7.0, Navy 5.3 and Air Force 3.6. The leading cause of death was embolic disease. CONCLUSION: The military MMR is closer to the Healthy People 2010 goal of 3.3 than is the national ratio, 13.2. Improved reporting of cases, patient education and treating high-risk conditions may help further decrease pregnancy-related mortality.     

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.     

Avoidable causes of perinatal death at or after term pregnancy in an inner-city hospital: medical versus social

A retrospective analysis of 174 consecutive singleton perinatal deaths at or after term pregnancy in an inner-city hospital was undertaken to determine avoidable causes of death. Adequate material was available in 161 cases. Twenty-eight infants with major malformations were excluded. The remaining 133 infants (95 stillbirths and 38 neonatal deaths) constituted the study population. An avoidable cause was defined as departure from the recognized standards of perinatal care that contributed to the deaths. Avoidable factors were present in 69 of 95 (73%) stillbirths. Contributing maternal/social and obstetric factors were present in 40 of 69 (58%) and 29 of 69 (42%) cases, respectively. Avoidable factors were found in 34 of 38 (89%) neonatal deaths. Contributing obstetric, maternal/social, and pediatric factors were present in 20 of 34 (59%), 12 of 34 (35%), and 2 of 34 (6%) cases, respectively. These results suggest that maternal/social causes were present more often than medical causes as a contributing factor in avoidable perinatal deaths at or after term pregnancy.     

Maternal mortality in Riyadh, Saudi Arabia

Summary. The maternal mortality in the Maternity and Children Hospital, Riyadh, during the years 1978–1980 was 52 per 100 000 births, when the total births were 55 428. This is higher than the rate reported from the hospitals in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand and Nigeria. Haemorrhage, associated disease, pulmonary embolism and infection, in that order, were the main causes of maternal deaths. The main avoidable factor was failure by the patient to seek the medical care. Much could be done in reducing deaths due to haemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole.     

Maternal mortality in Riyadh, Saudi Arabia

The maternal mortality in the Maternity and Children Hospital, Riyadh, during the years 1978-1980 was 52 per 100 000 births, when the total births were 55 428. This is higher than the rate reported from the hospitals in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand and Nigeria. Haemorrhage, associated disease, pulmonary embolism and infection, in that order, were the main causes of maternal deaths. The main avoidable factor was failure by the patient to seek the medical care. Much could be done in reducing deaths due to haemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole.     

Maternal mortality--a twelve-year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria

This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin over a 12-year period (1972-1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50 per 1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the third stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity services in our hospital, health education programs for the public and particularly the expectant women and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.     

Maternal mortality in Pernambuco, Brazil: what has changed in ten years?

This study examines changes in levels and patterns of maternal mortality in Pernambuco, Brazil, in 1994 and 2003. The research was carried out in five sub-regions of Pernambuco using the Reproductive Age Mortality Survey (RAMOS) method and based on death certificates of women of reproductive age registered in the local System of Information on Mortality. In-depth interviews with family members were also conducted for the abortion-related deaths. Of the 1,258 female deaths investigated, 54 maternal deaths were identified, corresponding to a maternal mortality ratio of 77 per 100,000 live births. The estimated level of under-reporting (46%) corresponds to an upward adjustment factor of 1.9. The illegal status of abortion in Brazil remains an important contributory factor for the abortion-related deaths. Approximately 94% of the maternal deaths were judged to be avoidable with improvements in health care. Maternal mortality declined by 30% over the ten-year period but the level of misclassification of maternal deaths remains. Improvements in maternity care for women and reporting of maternal deaths are still urgently needed.     

Perinatal mortality at King Fahd Hospital of the University Al-Khobar, Saudi Arabia

The perinatal deaths of all singleton births that occurred at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia during a 4-year period are analysed. The causes of death are classified into 12 groups using an extended modification of the Aberdeen classification. There were 165 perinatal deaths in 8057 singleton births, giving a perinatal mortality rate of 20.47 per 1000 total births. Fetal malformations occurred in 29 (17.57%) cases. Of the remaining 136 normal infants, 77 (56.6%) were stillbirths and 59 (43.4%) died within 1 week of delivery. Spontaneous premature labor was the commonest cause of death (23.52%) followed by birth trauma (11%) and maternal diseases (9.55%). The cause of death was not known in 22 (16.17%) cases. In conclusion, prevention of premature labor, better intrapartum fetal monitoring, early recognition of fetal distress and improvement of neonatal care should reduce the perinatal mortality rate.     

Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali

Objective Few prospective studies have been undertaken of maternal mortality in sub-Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako.
Design Prospective cohort study.
Setting Bankoni (population 59,000), a district of Bamako (population 700,000).
Population 5782 pregnant women identified during quarterly household visits.
Methods After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital.
Main outcome measures Maternal mortality ratio, late maternal mortality, likely cause of death.
Results Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery.
Conclusions This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.     

Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali.

OBJECTIVE: Few prospective studies have been undertaken of maternal mortality in sub-Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako. DESIGN: Prospective cohort study. SETTING: Bankoni (population 59,000), a district of Bamako (population 700,000). POPULATION: 5782 pregnant women identified during quarterly household visits. METHODS: After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital. MAIN OUTCOME MEASURES: Maternal mortality ratio, late maternal mortality, likely cause of death. RESULTS: Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery. CONCLUSIONS: This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.