Maternal death

Maternal death Classification and external resources
ICD-10	O95
ICD-9	646.9

Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2000, the United Nations estimated global maternal mortality at 529,000, of which less than 1% occurred in the developed world. However, most of these deaths have been medically preventable for decades, because treatments to avoid such deaths have been well known since the 1950s.

Contents 1 Maternal Mortality definition 2 Major causes 3 Maternal Mortality Ratio (MMR) 4 Associated risk factors 5 Maternal death rates in the 20th century 6 See also 7 References 8 External links

[edit] Maternal Mortality definition

According to the WHO, "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." ^[1]

Generally there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or their management, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem. Other fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.

Maternal mortality is a sentinel event to assess the quality of a health care system. However, a number of issues need to be recognized. First of all, the WHO definition is one of many; other definitions may also include accidental and incidental causes. Cases with "incidental causes" include deaths secondary to violence against women that may be related to the pregnancy and be affected by the socioeconomic and cultural environment. Also, it has been reported that about 10% of maternal deaths may occur late, that is after 42 days after a termination or delivery^[2], thus, some definitions extend the time period of observation to one year after the end of the gestation. Further, it is well recognized that maternal mortality numbers are often significantly underreported ^[3].

Reducing the maternal mortality by three quarters between 1990 and 2015 is a specific part of Goal 5 -Improving Maternal Health - of the eight Millenium Development Goals; its progress is monitored here^[4]

[edit] Major causes

The major causes of maternal death are bacterial infection, variants of gestational hypertension including pre-eclampsia and HELLP syndrome, obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism, and complications of abortions. Lesser known causes of maternal death include renal failure, cardiac failure, and hyperemesis gravidarum.

As stated by the 2005 WHO report "Make Every mother and Child Count" they are: severe bleeding/hemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labour (8%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anaemia^[5], HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.

Forty-five percent of postpartum deaths occur within 24 hours.^[6]

[edit] Maternal Mortality Ratio (MMR)

Maternal Mortality Ratio is the ratio of the number of maternal deaths per 100,000 live births. The MMR is used as a measure of the quality of a health care system. Sierra Leone has the highest maternal death rate at 2,000, and Afghanistan has the second highest maternal death rate at 1900 maternal deaths per 100,000 live births, reported by the UN based on 2000 figures. According to the Central Asia Health Review, Afghanistan's maternal mortality rate was 1,600 in 2007.^[7] Lowest rates included Iceland at 0 per 100,000 and Austria at 4 per 100,000. In the United States, the maternal death rate was 11 maternal deaths per 100,000 live births in 2005.^[8]

"Lifetime risk of maternal death" accounts for number of pregnancies and risk. In sub-Saharan Africa the lifetime risk of maternal death is 1 in 16, for developed nations only 1 in 2,800.

In 2003, the WHO, UNICEF and UNFPA produced a report with statistics gathered from 2000. The world average per 100,000 was 400, the average for developed regions was 20, and for developing regions 440. The worst countries were: Sierra Leone (2,000), Afghanistan (1,900), Malawi (1,800), Angola (1,700), Niger (1,600), Tanzania (1,500), Rwanda (1,400), Mali (1,200), Somalia, Zimbabwe, Chad, Central African Republic, Guinea Bissau (1,100 each), Mozambique, Burkina Faso, Burundi, and Mauritania (1,000 each).

[edit] Associated risk factors

High rates of maternal deaths occur in the same countries that have high rates of infant mortality reflecting generally poor nutrition and medical care.

Low birth weight of the child is correlated with maternal death from cardiovascular disease. Subtracting one pound of infant birth weight is correlated with the doubling of the risk of maternal death. Conversely, heavier child birth weight is correlated with lower risk of maternal death.^{[citation needed]}

Another issue that is associated with maternal mortality is the distance of traveling to the nearest clinic to receive proper care. In Third World countries, as well as rural areas, this is especially true. Traveling to and back from the clinic is very difficult and costly, especially to poor families when time could have been used for working and providing incomes. Even so, the nearest clinic may not provide decent care because of the lack of proper staff and equipment such as ones in the Guatemalan highlands. ^[9]

[edit] Maternal death rates in the 20th century

The death rate for women giving birth plummeted in the 20th century.

The historical level of maternal deaths is probably around 1 in 100 births^[10]. Mortality rates reached horrible proportions in maternity institutions in the 1800s, sometimes climbing to 40 percent of birthgiving women. At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. The number today in the United States is 11 in 100,000, a decline by orders of magnitude.^[11]

The decline in maternal deaths has been due largely to improved asepsis, use of caesarean section, fluid management and blood transfusion, and better prenatal care.^{[citation needed]} Recommendations for reducing maternal mortality include access to health care and emergency obstetric care, funding and intrapartum care.^[12] Moreover, political will and support play a major role and without it reforms to reduce maternal mortality cannot be made ^[13](5).

[edit] See also

• Endometritis


• List of women who died in childbirth


• Maternal health


• Perinatal mortality


• Puerperal fever


• Reproduction


• Reproductive health


• Stillbirth


• Unintended pregnancy

[edit] References

1. ^ Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June, 2008


2. ^ Koonin, Lisa M.; Hani K. Atrash, Roger W. Rochat, Jack C. Smith (12/1/1988). "Maternal Mortality Surveillance, United States, 1980–1985". MMWR 37 (SS-5): 19–29. http://www.cdc.gov/mmwR/preview/mmwrhtml/00001754.htm. 


3. ^ Deneux-Tharaux, D; Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. (2005). "Underreporting of Pregnancy-Related Mortality in the United States and Europe". Obstet Gynecol 106: 684–692. 


4. ^ Monitor of Goal 5 of the Millenium Developement Goals, access date=08-26-2008


5. ^ The commonest causes of anaemia are poor nutrition, iron and other micronutrient deficiencies, malaria, hookworm and schistosomiasis (2005 WHO report p45).


6. ^ Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Ob Gyn 1: 77–81. 


7. ^ Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June, 2008.


8. ^ [ http://www.who.int/whosis/mme_2005.pdf Maternal Mortality in 2005], access date=08-230-2008


9. ^ Thaddeus, S; Maine D (1994). "Too far to walk: Maternal mortality in context". Social Science & Medicine 38 (8): 1091–1110. doi:10.1016/0277-9536(94)90226-7. 


10. ^ See for instance mortality rates at the Dublin Maternity Hospital 1784–1849


11. ^ [ http://www.who.int/whosis/mme_2005.pdf Maternal Mortality in 2005], access date=08-230-2008


12. ^ Costello, A; Azad K, Barnett S (2006). "An alternative study to reduce maternal mortality.". The Lancet 368: 1477–1479. doi:10.1016/S0140-6736(06)69388-4. 


13. ^ Rosenfield, A; Min CJ, Freedman LP (2007). "Making motherhood safe in developing countries". England Journal of Medicine 356: 1395–1397. doi:10.1056/NEJMp078026. 

[edit] External links

• Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June, 2008.


• Maternal Mortality Estimates 2000 by the WHO & UNICEF


• Maternal Mortality Map by SHOW/World.


• The World Health Report 2005 – Make Every Mother and Child Count


• Confidential Enquiry into Maternal and Child Health (CEMACH) - UK triennial enquiry into "Why Mothers Die"


• Reducing Maternal Mortality in Developing Countries - Video, presentations, and summary of event held at the Woodrow Wilson International Center for Scholars, March 2008

v • d • e Pathology of pregnancy, childbirth and the puerperium (O, 630-676) Pregnancy with abortive outcome Ectopic pregnancy - Hydatidiform mole - Miscarriage Oedema, proteinuria and hypertensive disorders Pregnancy-induced hypertension - Pre-eclampsia - Eclampsia - Gestational diabetes Other, predominantly related to pregnancy Hyperemesis gravidarum - Gestational pemphigoid - Intrahepatic cholestasis of pregnancy Maternal care related to the fetus and amniotic cavity and possible delivery problems Polyhydramnios - Oligohydramnios - Chorioamnionitis - Premature rupture of membranes - Amniotic band syndrome - Placenta praevia - Braxton Hicks contractions - Antepartum haemorrhage - Placental abruption Complications of labour and delivery Premature birth - Postmature birth - Cephalopelvic disproportion - Dystocia (Shoulder dystocia) - Fetal distress - Vasa praevia - Uterine rupture - hemorrhage - Placenta accreta - Umbilical cord prolapse - Amniotic fluid embolism Maternal complications in the weeks after childbirth Puerperal fever - Peripartum cardiomyopathy - Postpartum thyroiditis - Galactorrhea - Postpartum depression Complications related to the fetus Fetal intervention - Fetal surgery Other Maternal death

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