Maternal mortality in southern israel

Summary Between 1969 and 1991 there were 166,410 births in Southern Israel with 13 maternal deaths (7.8/100,000). In the Jewish population there were 119,130 deliveries with 7 maternal deaths (5.9/100,000), and the Bedouins had 47,280 deliveries with 6 maternal deaths (12.7/100,000). Prenatal care was an important preventive factor. 7 maternal deaths occurred among 151,088 women who had received prenatal care (4.6/100,000), whereas 6 such deaths occurred among 15,322 without prenatal care (39.1/100,000) (P value 0.0005). Ten of the 13 women who died were over 24 years old. Eight of the 13 patients were multiparous. Live births occurred in 6 patients and stillbirths in 5 patients. Hemorrhage, preeclampsiaeclampsia and pulmonary embolism were the leading causes of maternal death.     

Maternal deaths associated with cesarean section in Enugu, Nigeria.

Maternal deaths from cesarean sections in Nigeria are exceptionally high and result from avoidable causes such as hemorrhagic shock, sepsis and hypertensive disorders in pregnancy. Increased involvement of specialists in the care and improved intra and post-operative management of cases are advocated to reduce the high maternal mortality rate.     

Experiences with facility-based maternal death reviews in northern Nigeria

Objective

To evaluate the effectiveness of the maternal death review (MDR) system and process in improving quality of maternal and newborn health care in northern Nigeria.

Methods

A combination of quantitative and qualitative methods was used, including review of MDR forms and of health management information system data on maternal deaths (MDs), as well as semi-structured interviews with members of 11 MDR committees.

Results

Facility-based MDRs were initiated in 75 emergency obstetric and newborn care facilities in northern Nigeria and were initially conducted in the 33 hospitals; however, the process stopped after some time and had to be revitalized. Main reasons were transfer of key members of MDR committees, lack of supportive supervision, and shortage of staff. Ninety-three (12.1%) of 768 identified MDs were recorded on MDR forms and 52 (6.7%) had been reviewed. MDRs resulted in improved quality of care, including mobilization of additional resources. Challenges were fear of blame, shortage of staff, transfer of MDR team members, inadequate supportive supervision, and poor record keeping.

Conclusion

MDR requires teamwork, commitment, and champions at health facility level to spearhead the process. MDR needs to be institutionalized in the Ministry of Health, which provides oversight, policy guidance, and support, including supportive supervision.     

Determinants of perinatal mortality in Nigeria

Objective

To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria.

Methods

The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period.

Results

Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia.

Conclusion

The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death.     

Acceptance of evidence-based reproductive health care among postgraduate specialist trainees in Nigeria.

OBJECTIVE: To assess the perception and practice of evidence-based reproductive health care among Nigerian postgraduate specialist trainee doctors. METHOD: A questionnaire survey of 326 Nigerian postgraduate specialist trainee doctors involved in reproductive health care was undertaken during training workshops on evidence-based medicine. RESULTS: Most respondents were familiar with evidence-based medicine (96.6%) and agreed that it would improve patient care (95.1%). Only 38.3% had ever received training on evidence-based medicine. Awareness and utilization of resources for evidence-based medicine were low; only 18.7% and 28.2% had ever used the Cochrane Library or the WHO Reproductive Health Library, respectively. Understanding of technical terms related to evidence-based medicine was poor. Lack of access to evidence was the most common constraint to the practice of evidence-based reproductive health care. CONCLUSION: Nigerian postgraduate specialist trainee doctors are positively disposed to evidence-based reproductive health care but their understanding of the principles of evidence-based practice is inadequate.     

Maternal mortality in Bavaria between 1983 and 2000

OBJECTIVE: This study was undertaken to identify the main causes of maternal mortality within a developed country to refocus and enhance the delivery of obstetric services. STUDY DESIGN: From January 1, 1983, to December 31, 2000, 309 maternal deaths occurring in Bavaria were documented and classified in a prospective observational study. The data sources were the civil registry, confidential reports by members of the Bavarian Society of Obstetrics and Gynecology, and public information. Direct obstetric death, indirect obstetric death, and coincidental death account for 164, 67, and 78 cases, respectively. They were expressed as the maternal mortality ratio (MMR: maternal deaths/100,000 live births) over the 18-year study period divided into three 6-year intervals 1983 to 1988, 1989 to 1994, and 1995 to 2000. RESULTS: The direct obstetric mortality ratio (DOMR: direct obstetric deaths/100,000 live births) decreased from 11.3 in the study period 1983 to 1988 to 5.4 in the study period 1995 to 2000 (P<.0005), mainly because of a reduction in antepartal and intrapartal deaths. The main cause of direct obstetric death was thromboembolism, including amniotic fluid embolism, which remained unchanged over the study period; other causes of direct obstetric death decreased markedly but not significantly. CONCLUSION: Careful analysis of the Bavarian maternal mortality data identified postpartum maternal deaths to be unchanged during the study period. In particular, effective prevention and treatment of thromboembolism should be a prior focus for obstetric care.     

全国孕产妇死亡监测结果分析

目的 了解我国各地区孕产妇死亡率、死亡原因及影响因素,提出降低孕产妇死亡率的对策与措施。方法 根据全国及各省的人口数进行分层整群抽样,形成覆盖全国１．０亿人口的２４７个监测点,对监测资料进行分析。结果 监测地区７年内活产总数为８７０９２２０例,孕产妇死亡率７年平均为７７．４／１０万,其中城市为４５．５／１０万,农村为９５．４／１０万;全国不同地区孕产妇死亡率为２６．０／１０万￣３０８．０／１０万不     

Maternal and perinatal outcome of eclampsia in tertiary health institution in Southeast Nigeria

Objective: To evaluate the maternal and perinatal outcome in patients with eclampsia at Nnamdi-Azikiwe-University-Teaching-Hospital (NAUTH), Nnewi, Nigeria. Methods: A retrospective study of cases of eclampsia managed at NAUTH over a 10 year period – 1st January, 2000 to 31st December, 2009. Maternal outcome was measured in terms of complications and maternal death. Foetal outcome was assessed in terms of low birth weight, pre-term births, low apgar score, and perinatal deaths. Results: There were 57 cases of eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. Majority, 71.7%, had caesarean section. There were 17.4% maternal deaths mainly from pulmonary oedema, 6 (13.0%), acute renal failure, 4 (8.7%), and coagulopathy, 3 (6.5%). Perinatal deaths were 25.5% as a result of prematurity, 42 (82.4%), and low birth weight, 36 (70.6%). Twenty-one (41.2%) of the new born had Apgar score of less than seven at 5?min while 13.0% were severely asphyxiated. Conclusion: Eclampsia was associated with high maternal and perinatal morbidity and mortality in this study. There is need to review existing protocol on eclampsia management with emphasis on appropriate health education of pregnant mothers, good antenatal care, early diagnosis of pre-eclampsia with prompt treatment.     

Maternal mortality in Greece, 1996-2006

Objective

To present retrospective data for maternal deaths in Greece from 1996 to 2006.

Methods

Demographic information and information on the causes of death was provided by the Hellenic Statistical Authority. Maternal deaths were assessed by cause of death, maternal age, and place of residence. The maternal mortality ratio (MMR) was estimated and expressed as the number of deaths per 100 000 live births.

Results

From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth, yielding a total MMR of 2.63. The leading cause of direct deaths was hemorrhage and that of indirect deaths was cardiac disease. There was a borderline significant decline in the MMR during the study period. The MMR was significantly higher at the extremes of the reproductive age range.

Conclusion

Maternal mortality in Greece is low; however, no formal data have been published since 1996. Knowledge of the causes of maternal death can lead to the prevention of maternal deaths and safer motherhood.     

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.     

Maternal risk factors associated with fetal death during antenatal care in low-resource tertiary hospitals

BACKGROUND: Data on maternal characteristics that could predict antepartum fetal death in women receiving antenatal care in resource-constrained settings are limited. Aims: To identify maternal sociodemographic and clinical risk factors for antepartum fetal death among women receiving antenatal care in a developing country setting. METHODS: Case-control analyses of risk factors in the occurrence of singleton fetal death before labour at two university hospitals in south-west Nigeria over 4-5 years. A total of 46 cases and 184 controls were compared for 31 sociodemographic and clinical risk factors. Unconditional multivariate logistic regression analysis was applied to determine independent risk factors. Level of significance was set at P < 0.05. RESULTS: The incidence of antepartum fetal death among women receiving antenatal care was 10.8 per 1000 total births during the period. Significant risk factors at univariate level include proteinuria, pregnancy-induced hypertension, pre-existing hypertension, reduced weight gain per week, previous antepartum fetal death, antepartum haemorrhage, previous miscarriage, symphysiofundal height-gestational age disparity = 4 cm and perception of reduced fetal movements. The independent risk factors were proteinuria (adjusted OR 4.23, CI: 1.57-11.42), pregnancy-induced hypertension (adjusted OR 8.24, CI: 3.01-22.51) and perceived reduction in fetal movements (adjusted OR 7.17, CI: 1.57-45.76). CONCLUSIONS: The identified factors should serve as potential targets for antenatal interventions to prevent antepartum fetal death in these institutions. Awareness of these factors should stimulate appropriate risk assessment geared towards the prevention of antepartum fetal deaths by clinicians in these centres and centres in similar setting.     

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 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.     

Maternal mortality in Maiduguri, Nigeria.

Maternal mortality is an index of the standard of antenatal care in a given environment. In developed countries the level of antenatal care has risen to an extent that maternal mortality has virtually disappeared (Nylander and Adekunle, 1990). This is in sharp contrast with the situation in developing countries like Nigeria where maternal mortality is still deplorably high. According to the World Health Organization, only 29-36% of deliveries in Africa are attended to by trained health personnel (World Health Organization, 1985). Therefore the mortality rates reported from most developing countries may be just the tip of the iceberg. Another disturbing dimension to the problem of maternal deaths in developing countries is the fact that most of the deaths are due to causes that can be prevented by the provision of essential obstetric care. Nearly a decade after the launching of the international safe motherhood initiative the tragedy of maternal deaths remains unmitigated in most developing countries such as Nigeria. The purpose of this study is to evaluate the causes of maternal deaths in two tertiary level hospitals in Maiduguri, north-eastern Nigeria and to identify ways of reversing the trend.     

Maternal mortality in a rural referral hospital in the Niger Delta, Nigeria.

Almost two decades after the safe motherhood initiative, maternal mortality figures remain very high in Nigeria. Very few studies are available on the features of maternal mortality in rural Nigeria. The objective of this study was to determine the incidence and causes of maternal mortality in a rural referral hospital in the Niger Delta, Nigeria. An audit of 115 consecutive maternal mortalities over a 10-year period at a rural-based tertiary hospital was undertaken. There were 5,153 deliveries and 115 maternal deaths during the study period, with a maternal mortality ratio of 2,232/100,000 live births. The most common causes of maternal mortalities were puerperal sepsis, abortion complications, pre-eclampsia/eclampsia, prolonged obstructed labour, haemorrhage accounting for 33%, 22.6%, 17.4%, 13.0% and 7.8%, respectively. The percentage mortality for unbooked was 10 times that for booked patients. Unbooked status is a risk factor for maternal mortality as this was statistically significant p < 0.0001. Traditional birth attendants were involved in the initial management of at least two-fifths (38.2%) of the non-abortion mortalities while half had been managed in private hospitals and maternities. Maternal mortality will continue to increase unless appropriate steps are taken to improve the use of antenatal care, thereby reducing unbooked emergencies. Hospitals need to be equipped with facilities for emergency obstetric care. Continuous programmes that will integrate TBAs and orthodox practices should be put in place as this will reduce delays and improve referral systems.     

Problems of obstetric care in Nigeria

The problems of obstetric care in Nigeria are multifactorial, enormous but represent inevitable evolutionary stages through which every community in the world must pass. In a population of around 90 million, there is one doctor for every 11,000 people and only 35% of the population is at present covered by any form of modern health care services. There are fewer than 500 doctors with specialist obstetric qualifications and many of them are concentrated in the large cities. A disquietingly small number (17%) of our women are delivered by personnel with modern obstetric knowledge; 83% are delivered by traditional birth attendants. The maternal mortality rate is around 8/1000, and the perinatal mortality is about 60/1000. Currently less than 20% of the population is educated. Only 3% of the national budget is devoted to health. A proper communication system so vital to the establishment of liaison between doctors and the community of patients is virtually non-existent. These problems are compounded by hostile environmental factors. A mixture of tribal, superstitious and religious practices permit marriages as early as 10 years of age and prevent women in labor from seeking medical attention in a timely fashion. Fortunately programmes for improved obstetric care are being expanded. Thus the present difficulty of working in an unfavorable and challenging situation may well be worthwhile.     

Factors associated with maternal near-miss morbidity and mortality in Kowloon Hospital,Suzhou, China

Objective

To investigate factors associated with acute maternal morbidity and mortality in Kowloon Hospital, Suzhou, China.

Methods

Data from cases of near-miss and maternal death between January 2008 and December 2012 were reviewed retrospectively. Maternal characteristics and related factors were identified, and multiple regression analysis was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results

During the study period, there were 18 104 deliveries, 69 near-miss cases, and 3 maternal deaths. Women who had no health insurance (aOR, 4.55; 95% CI, 0.87–21.8), had fewer than 6 prenatal consultations (aOR, 6.76; 95% CI, 0.76–45.8), were part of a migrant population (aOR, 2.34; 95% CI, 0.45–24.9), or delayed seeking healthcare (aOR, 4.76; 95% CI, 0.89–13.6) had a greater risk of near-miss morbidity or death. Admission to intensive care (aOR, 6.75; 95% CI, 0.89–34.6) and blood transfusion within 30 min (aOR, 3.79; 95% CI, 0.65–8.67) were protective factors in disease progression.

Conclusion

The factors associated with maternal near-miss morbidity and mortality were closely related to health insurance and socioeconomic status, suggesting that the government should take an active role in the community in preventing morbidity and mortality in pregnancy.     

Maternal mortality surveillance in Jamaica.

OBJECTIVES: To assess factors associated with under-reporting of maternal deaths from 1998, when maternal deaths became a Class I notifiable event in Jamaica and continuous maternal mortality surveillance was introduced, through 2003. METHODS: The number of deaths notified was compared with the number of independently identified deaths for each period and region studied, and key informants reported on their experience of the surveillance process. RESULTS: By 2000, approximately 80% of maternal deaths were reported, and was more consistent in 2 of the 4 regions. In these 2 regions someone was responsible for active surveillance and there was an established maternal mortality committee to review cases. Factors associated with nonreporting were no postmortem examination, death in the first trimester of pregnancy, and time interval between pregnancy termination and death. The surveillance staff requested guidelines on monitoring interregional transfers and technical assistance in developing action plans. CONCLUSION: Active hospital surveillance must include all wards, including the emergency department. Community surveillance should include forensic pathologists. National leadership is needed to summarize trends, address policy, and provide technical assistance to the surveillance staff.