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 in an urban tertiary care hospital of north India

Objectives

The aims of the study were to help generate information and knowledge regarding the causes and complications leading to maternal deaths (MDs) in an urban tertiary care hospital, to find if any of them are potentially preventable, and to use information thus generated to save lives.

Methods

The medical records of all MDs occurring over a period of 4 years between January 2003 and December 2006 were reviewed and correlated with maternal age, antenatal registration, mode of delivery, parity, admission death interval, and causes of death.

Results

The maternal mortality rate (MMR) ranged between 926 and 377/100,000 births in the study period. The causes of deaths were sepsis 23.84%, eclampsia /pregnancy-induced hypertension 17.69%, hemorrhage 13.84%, hepatitis 13.84%, anemia 13.07%, respiratory infections 8.46%, other indirect obstetrical causes 6.15%, and unrelated causes 4.61%. Maximum deaths (71.53%) occurred in women between 21 and 30 years of age while multigravida had MMR of 51.53%. Mortality was highest in postnatal mothers 63.06%.Unbooked cases constituted 92.31% of MDs and included 25% referred cases.

Conclusion

Overall maternal mortality was 690/100,000. MDs due to direct obstetric causes were 55.38%, indirect obstetric deaths 40%, and unrelated deaths 4.61%. The causes of potentially preventable deaths include deaths due to anemia, sepsis, hemorrhage, DIC, and anesthesia complication, and accounted for 25.38% of all deaths.     

Maternal Mortality: A FOGSI Study (Based on Institutional Data)

Objective

The aim of this study of maternal deaths through FOGSI members is to see its current STATUS.

Method

A three-year retrospective observational study from January 2005 to December 2007 formed the basis for collection of the data for analysis.

Results

A wide variation of maternal mortality ratio (MMR) in the five zones (West—342; South—229; East—709; North East—709 and North—814) was observed. Leading causes of maternal deaths also varied among the zones [hemorrhage in West (31 %), South (26 %), and North East (21.5 %); hypertension in East (34 %) and North (22 %)]. When the data were analyzed as a whole, the leading causes of deaths were determined as hypertension (29.4 %), hemorrhage (21.56 %), sepsis (15.05 %), and medical disorders (12 %). Analysis of data in India (including Kerala State) for the year 2005 revealed significant drop in MMR to 147.

Conclusion

MMR in India varied widely in zones. There is significant difference in MMR for the whole country as well as for the south zone with or without inclusion of Kerala. Areas of discrepancy in data had been observed in different sources. Prioritization of causes of death and appropriate allocation of resources are needed. A prospective study for evaluation of exact MMR in India is an immediate necessity.     

Factors associated with antenatal mental disorder in West Africa: A cross-sectional survey

Background

The maternal mortality ratio in Sudan was estimated at 750/100,000 live births. Sudan was one of eleven countries that are responsible for 65% of global maternal deaths according to a recent World Health Organization (WHO) estimate. Maternal mortality in Kassala State was high in national demographic surveys. This study was conducted to investigate the causes and contributing factors of maternal deaths and to identify any discrepancies in rates and causes between different areas.

Methods

A reproductive age mortality survey (RAMOS) was conducted to study maternal mortality in Kassala State. Deaths of women of reproductive age (WRA) in four purposively selected areas were identified by interviewing key informants in each village followed by verbal autopsy.

Results

Over a three-year period, 168 maternal deaths were identified among 26,066 WRA. Verbal autopsies were conducted in 148 (88.1%) of these cases. Of these, 64 (43.2%) were due to pregnancy and childbirth complications. Maternal mortality rates and ratios were 80.6 per 100,000 WRA and 713.6 per 100,000 live births (LB), respectively. There was a wide discrepancy between urban and rural maternal mortality ratios (369 and 872\100,000 LB, respectively). Direct obstetric causes were responsible for 58.4% of deaths. Severe anemia (20.3%) and acute febrile illness (9.4%) were the major indirect causes of maternal death whereas obstetric hemorrhage (15.6%), obstructed labor (14.1%) and puerperal sepsis (10.9%) were the major obstetric causes. Of the contributing factors, we found delay of referral in 73.4% of cases in spite of a high problem recognition rate (75%). 67.2% of deaths occurred at home, indicating under utilization of health facilities, and transportation problems were found in 54.7% of deaths. There was a high illiteracy rate among the deceased and their husbands (62.5% and 48.4%, respectively).

Conclusions

Maternal mortality rates and ratios were found to be high, with a wide variation between urban and rural populations. Direct causes of maternal death were similar to those in developing countries. To reduce this high maternal mortality rate we recommend improving provision of emergency obstetric care (Emoc) in all health facilities, expanding midwifery training and coverage especially in rural areas.     

Second-line treatment of postpartum haemorrhage (PPH)

Introduction

Postpartum haemorrhage (PPH) remains to be the most common cause of maternal mortality and is responsible for 25?% of the maternal deaths worldwide. Although the absolute risk of maternal death is much lower, a recent increase of PPH and related maternal adverse outcomes has been noted in high-income countries as well. Generally, PPH requires early recognition of its cause, immediate control of the bleeding source by medical, mechanical, invasive-non-surgical and surgical procedures, rapid stabilization of the mother??s condition, and a multidisciplinary approach. Second-line treatment of PPH remains challenging, since there is a lack of univocal recommendations from current guidelines and sufficient data from randomized controlled trials.

Materials

For this review, electronic searches were performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials using the keywords ??postpartum haemorrhage?? in combination with ??uterine tamponade?? and, especially with ??arterial embolisation??, ??uterine compression sutures??, and ??post(peri)partum hysterectomy?? (from January 2000 to November 2011). Reference lists of identified articles were searched and article references to the keywords selected.

Results

Treatment options such as uterine compression sutures, embolisation, arterial ligation and hysterectomy were evaluated with regard to their prerequisites, benefits, drawbacks and respective success rate. In addition, a treatment algorithm for the second-line treatment of PPH is presented.     

Brought in Dead: An Avoidable Delay in Maternal Deaths

Purpose

Maternal brought in dead are the patient who dies in the need of adequate medical care. These deaths are often not analyzed sincerely as they are not institutional deaths. Our aim is to find out actual life threatening cause of delay leading to death.

Method

Patients brought dead to casualty were seen by the doctors on duty in Department of Obstetrics and Gynaecology,Gandhi Medical College, Bhopal round the clock. Cause of death was analyzed by verbal autopsy of attendants and referral letter from the institute. In this analytical study a complete evaluation of brought deaths from January 2011 to Decmeber 2014 was done.

Results

A total of 64 brought in deaths were reported in this 4 year duration. Most common cause of death was postpartum hemorrhage (54.68 %) followed by hypertension (15.62 %) and the most common cause of delay was delay in getting adequate treatment (56.25 %).

Conclusion

The brought in dead are the indicator of the three delays in getting health care. Challenges appear to be enormous to be tackled. Timely management proves to be critical in preventing maternal death. Thus it appears that community education about pregnancy and its complications, EmOC training at FRU and strict adherence to referral protocol may help us to reduce the brought dead burden.

     

Maternal mortality ratio in selected rural communities in Kebbi State,Northwest Nigeria

Background

Maternal mortality remains a topical issue in Nigeria. Dearth of data on vital events posed a huge challenge to policy formulation and design of interventions to address the scourge. This study estimated the lifetime risk (LTR) of maternal death and maternal mortality ratio (MMR) in rural areas of Kebbi State, northwest Nigeria, using the sisterhood method.

Methods

Using the sisterhood method, data was collected from 2917 women aged 15–49?years from randomly selected rural communities in 6 randomly selected local government area of Kebbi State. Retrospective cohort of their female siblings who had reached the childbearing age of 15?years was constructed. Using the most recent total fertility rate for Kebbi State, the lifetime risk and associated MMR were estimated.

Result

A total of 2917 women reported 8233 female siblings of whom 409 had died and of whom 204 (49.8%) were maternal deaths. This corresponds to an LTR of 6% (referring to 11?years before the study) and an estimated MMR of 890 deaths/100,000 live births (95% CI, 504–1281).

Conclusion

The findings provide baseline information on the MMR in rural areas of the State. It underscores the need to urgently address the bane of high maternity mortality, if Kebbi State and Nigeria in general, will achieve the health for all by year 2030 as stated in the Sustainable Development Goals (SDGs).

     

Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons

Objective

The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies.

Methods

We reviewed the obstetric records of all singleton and twin deliveries after 22?weeks’ gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma ≥6?cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia.

Results

Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95?% confidence interval (CI) 1.2–4.6, p?<?0.01], placenta previa (OR 8.08, 95?% CI 3.9–16, p?<?0.01) and placental abruption (OR 12.8, 95?% CI 2.3–76, p?<?0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41?weeks (OR 8.20, 95?% CI 1.3–40, p?<?0.01) and hypertensive disorders (OR 5.45, 95?% CI 2.2–14, p?<?0.01).

Conclusions

The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries.     

Antenatal screening for Group B Streptococcus: A diagnostic cohort study

Background

Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented.

Methods

Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions.

Results

Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity.

Conclusions

In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity.     

Evaluation of Severe Maternal Outcomes to Assess Quality of Maternal Health Care at a Tertiary Center

Background

Maternal mortality and near-miss index reflect the quality of care provided by a health facility. The World Health Organization recently published near-miss approach where strict near- miss criteria based on markers of organ dysfunction are defined.

Objectives

The aim of the study was to determine the frequency of severe maternal complications, maternal near-miss cases and maternal deaths, to analyze causes of near-miss and maternal mortality and to determine the values of maternal near-miss indicators.

Methods

This was a prospective observational study conducted at a tertiary care centre in North India from January 2012 – March 2013. WHO's near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.

Results

The number of women attending our facility with severe maternal complications was low (205 in 6,767 live births); as a result maternal near-miss ratio (MNMR) was low; 3.98/1,000 live births; Overall Maternal near-miss mortality ratio (MNM:1MD) was also low, 3.37:1, because of strict criterion of labeling near-miss and delay in referral to the hospital. Hypertensive disorder (37.5 %) was the commonest underlying cause for maternal mortality.

Conclusion

Basic implementation of WHO near-miss approach helped in the systematic identification and evidence-based management of severe maternal complications thereby improving the quality of maternal health in a developing country.

     

Determinations of antepartum fetal death

Objectives

This study was conducted to analyze the maternal and fetal etiologies of intrauterine fetal death, and to assess the diagnostic accuracy of an antenatal ultrasound, in the year 2007–208, at Lady Goschen Hospital, Mangalore.

Methods

The study is a prospective, non interventional, observational study, with 28 women as the subjects. Women admitted to the labor room with intrauterine fetal death, were counseled for fetal autopsy after delivery. Written and informed consent was taken from the couple for the autopsy examination, and fetus with the placenta was sent to Kasturba Medical College, Pathology Department for histopathology.

Results

Peak incidence was seen among the women 25–30 years of age with most of them being gravida two (46.43%). Maternal hypertensive disorders (28.56%) and fetal anomalies (32.14%) were the most common associations with fetal death. Unexplained etiology of fetal death was associated with gestational age of 36 weeks or more (75%), mostly in primigravida (43%), with fewer than four antenatal visits. Ultrasound was able to detect 55.55% of fetal anomalies antenatally.

Conclusions

Fetal autopsy is a must in accurately diagnosing the cause of fetal death. This has a bearing on the future pregnancy with respect to risks of recurrence.     

Prepregnancy obesity and the risk of gestational diabetes mellitus

Background

Investigation of maternal near-miss is a useful complement to the investigation of maternal mortality with the aim of meeting the United Nations' fifth Millennium Development Goal. The present study was conducted to investigate the frequency of near-miss events, to calculate the mortality index for each event and to compare the socio-demographic and obstetrical data (age, parity, gestational age, education and antenatal care) of the near-miss cases with maternal deaths.

Methods

Near-miss cases and events (hemorrhage, infection, hypertensive disorders, anemia and dystocia), maternal deaths and their causes were retrospectively reviewed and the mortality index for each event was calculated in Kassala Hospital, eastern Sudan over a 2-year period, from January 2008 to December 2010. Disease-specific criteria were applied for these events.

Results

There were 9578 deliveries, 205 near-miss cases, 228 near-miss events and 40 maternal deaths. Maternal near-miss and maternal mortality ratio were 22.1/1000 live births and 432/100 000 live births, respectively. Hemorrhage accounted for the most common event (40.8%), followed by infection (21.5%), hypertensive disorders (18.0%), anemia (11.8%) and dystocia (7.9%). The mortality index were 22.2%, 10.0%, 10.0%, 8.8% and 2.4% for infection, dystocia, anemia, hemorrhage and hypertensive disorders, respectively.

Conclusion

There is a high frequency of maternal morbidity and mortality at the level of this facility. Therefore maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal-near miss events (hemorrhage, infections, hypertension and anemia) at all care levels including primary level.     

Review of Twin Pregnancies with Single Fetal Death: Management,Maternal and Fetal Outcome

Aim

To study management and maternal and fetal outcome in single fetal death in twin pregnancies.

Materials and Methods

We studied 64 (1.37 %) twin deliveries out of a total of 4,655 deliveries in GMC, Haldwani (Uttrakhand). Out of them, 5 (7.81 %) were complicated with single fetal death in the second or third trimester. These cases were managed conservatively with regular monitoring of maternal coagulation profile along with intensive fetal surveillance for the surviving twin. The cases were studied for antenatal complications and placental chorionicity with placental histopathology and postmortem of the dead fetus. Neonatal and maternal outcome in the postpartum period was also studied.

Results

No antenatal complications were present in four out of five cases with one having PIH. Three out of five pregnancies could be extended to term and had no maternal complications. The other fetus could be salvaged in three and all of them had a normal neonatal period. One pregnancy ended in preterm labor with delivery of a preterm baby which could not be saved. One resulted in death of the other fetus also where pregnancy was remote from term.

Conclusions

Although our study was small, it indicates that in case of twin pregnancy with single fetal death with good surveillance, the live fetus can be salvaged.     

In Pursuit of Solving a Global Health Problem: Prototype Medical Device for Autotransfusing Life-Threatening Postpartum Hemorrhage in Resource-Limited Settings

Purpose of Review

The purpose of the review is to provide an overview of innovative technologies being developed to prevent and treat postpartum hemorrhage in resource-limited settings and to discuss a promising new device designed specifically to address the lack of safe blood supplies in many areas of the world.

Recent Findings

There are several new technologies being used or tested to address the significant global health problem of postpartum hemorrhage, the leading cause of maternal morbidity and mortality worldwide. None of these new technologies have addressed the persistent lack of safe blood supplies in low resource settings which is an essential pillar of comprehensive emergency obstetric care. With this aim in mind, a prototype obstetrical medical device was designed with the capability to autotransfuse women suffering life-threatening postpartum hemorrhage in low resource settings.

Summary

Postpartum hemorrhage remains the leading cause of maternal morbidity worldwide and efforts are needed, more than ever, to achieve the Sustainable Development Goals of improving maternal mortality especially in resource-limited settings. Despite many effective new technologies such as the non-pneumatic anti-shock garment, improvised uterine balloon tamponade devices, and new drugs such as tranexamic acid, none has addressed the lack of safe blood supplies that are critical to treating PPH. A prototype medical device has been developed, and preliminary testing for functionality and filter function has been successful and shows great promise. Further testing is still needed and is ongoing in preparation for human clinical trials.

     

La mortalité maternelle en France est-t-elle toujours plus élevée que dans les autres pays européens ? Mise au point avec des données de routine

Background

In 1996, an European study showed that maternal mortality and frequency of deaths due to hemorrhages were higher in France than in other countries. This study aims to update with routine data.

Methods

We compared the maternal mortality ratio and the frequency of causes during the period 2000–2004 among France, United Kingdom (UK), and the Netherlands. The data were collected from WHO and the demographic yearbooks. Direct standardization, Z-test, and Chi-square statistics were used.

Results

The standardized maternal mortality ratios were 7.5, 7.5, and 6.7 per 100,000 live births in France, UK, and the Netherlands, respectively. In France, the ratio decreased between 1990–1994 and 2000–2004 from 11.2 to 7.5 per 100,000 live births. However, the hemorrhages are persisting as the predominant obstetrical cause in France, whereas they are the indirect causes in the UK, and the hypertensive complications are the cause in the Netherlands.

Conclusion

France seems to fill up its delay, thanks to the implementation of the confidential inquiries into maternal death recommendations, launched since 1996. More studies are needed to deal with the hemorrhages.     

A Comparative Study of Feto-Maternal Outcome in Instrumental Vaginal Delivery

Objective

To compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery.

Material and Method

Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 120 cases were included in this prospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, instrumental injuries, NICU admissions PNM etc. χ² test was used to analyze the data.

Observations

Maternal morbidity viz. episiotomy extension as well as first and second degree perineal tear were significant in the forceps group (P = 0.0001 and P = 0.02, respectively). With regards to neonatal morbidity, no statistically significant difference was noted.

Conclusion

Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.     

Role of Neuroimaging in Patients with Atypical Eclampsia

Need

Despite availability of intensive care units and improved antenatal care, some women still die from Eclampsia. Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment.

Aims and Objectives

(1) To study the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it. (2) To study the role of neuroimaging in patients with atypical eclampsia.

Methodology

Prospective study design included 30 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO₄ therapy and antihypertensives. The patients who are refractory to the treatment such as having recurrent convulsions despite therapy MgSO₄ were selected for neuroimaging with CT scan. Neuroimaging is done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard.

Result

Pregnancy outcomes amongst thalassemia traits

Objective

To compare the pregnancy outcome between pregnancies affected and not affected by thalassemia trait.

Methods

A retrospective case–control cohort study was conducted on singleton pregnant women who attended antenatal care and delivered at Songklanagarind Hospital. All of the participating thalassemia trait pregnant women were diagnosed based on hemoglobin typing and/or DNA analysis. A ratio of around 1–1 was used to compare their pregnancy outcomes with normal pregnant women.

Results

Seven hundred thirty-nine thalassemia trait and 799 normal pregnant women were included in the study. All of the women were Thai nationals living in the Southern Region of Thailand and nearly all of them had spontaneously conceived. Maternal complication rates of gestational diabetes, preterm birth, antepartum bleeding, postpartum bleeding, shoulder dystocia and puerperal morbidity, and the rates of neonatal complications: macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR), stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were not significantly different between the two groups. The rate of pre-eclampsia, however, was significantly different, with RRs of 1.73 (CI 1.01–3.00).

Conclusion

The thalassemia trait condition did not affect the risk of gestational diabetes, postpartum hemorrhage, stillbirth, preterm birth and puerperal morbidity. However, pre-eclampsia should be warranted especially among nulliparous and high-BMI pregnant women.     

Cerebrovascular Complications in Pregnancy and Puerperium

Objectives

The aim of this study was to analyze the incidence, possible etiological factors, pathology, clinical manifestations, brain CT scan features, treatment, and prognosis of cerebrovascular complications occurring in pregnancy and puerperium.

Methodology

This is a prospective analytical study conducted at the Govt. Hospital for women and children, Chennai, from January 2006 to February 2008. During the above period, 26 women were diagnosed with various cerebrovascular complications. In these patients, the clinical data, risk factors, neurological features, investigations, results, and neuroimaging reports were analyzed.

Results

The incidence of cerebrovascular complications in this study was 66 per 100,000 deliveries. None had prior history of diabetes, hypertension, renal disease, or seizure disorder. Two women were suffering from cardiac disease. PET and eclampsia were seen in 19/26 (73 %) cases. Seven women were suffering from anemia and one with severe sepsis. The neurological complications manifested predominantly in the postpartum period. Cases presented with hemiplegia/facial palsy and aphasia. CT scan imaging showed intracerebral hemorrhage in four cases, cerebral infarcts in five cases, and cortical vein thrombosis in 16 cases. There were five maternal deaths in this study.

Conclusion

Stroke occurring in pregnancy, though rare, is a serious complication which can lead to maternal death. In this study, hypertension has emerged as an important risk factor; therefore, attention should be focussed on maintaining normotension in the peripartum period.     

Reliability and validity of the German version of the Maternal–Fetal Attachment Scale

Objectives

In understanding early disturbances in the mother–child relationship, maternal–fetal attachment has become an important concept. To date no study has investigated the reliability and validity of the German version of the Maternal Fetal Attachment Scale (MFAS). The present study aimed to close this gap.

Methods

Questionnaires were completed in a sample of 324 women [third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3)]. In addition to the MFAS (T1), the following measures were assessed: the questionnaire of partnership (T1), the postpartum bonding questionnaire (T2), the Edinburgh Postnatal Depression Scale (T1–T3), the State Trait Anxiety Inventory (T1–T3), and the pregnancy related anxiety questionnaire (T1–T3). Factor structure was analyzed using a principal component analysis (PCA) with varimax rotation. Internal and convergent validities were calculated.

Results

In contrast to the original version with five subscales, PCA yielded a three-factor solution, consisting of the three independent dimensions “anticipation”, “empathy”, and “caring”, explaining 34.9% of the variance together. Good internal reliabilities were found for the total MFAS scale. Maternal–fetal attachment showed a significant negative correlation with postpartum bonding impairment. While no correlations were found with depression, general anxiety and pregnancy-related anxiety during pregnancy, maternal–fetal attachment was significantly related to aspects of partnership quality. In the postpartum period, maternal attachment showed a strong negative correlation with maternal anxiety.

Conclusions

Our results suggest that the German version of the MFAS is a reliable and valid questionnaire to measure the emotional relationship of the mother to the unborn child during pregnancy.