Document Detail


Maternal mortality and its prevention.
MedLine Citation:
PMID:  1809606     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Maternal mortality rates in developed countries have declined steeply during the last 50 years. The introduction of sulphonamides and blood transfusion techniques contributed much to lowering maternal mortality rates. The maternal mortality rate in The Netherlands in 1983-1988 was 8.8/100,000 livebirths. In 57% substandard care factors could be identified. This suggests that further improvement in preventing maternal mortality is possible. Maternal mortality rates in developing countries are still unacceptably high as a result of high fertility and a high risk of dying each time a woman becomes pregnant. Complications of illegal abortion are responsible for 25-50% of maternal deaths. Safe contraception could probably result in an important reduction in the number of maternal deaths, but also the provision of accessible maternal health services is essential to reduce maternal mortality in developing countries.
Physicians analyzed 1983-88 data on 99 maternal deaths in the netherlands to examine causes of death and to what degree substandard care contributed to the deaths. 65 cases were classified as direct maternal deaths, 14 ad indirect maternal deaths, and 20 as fortuitous maternal deaths. They did not include the 20 fortuitous deaths in the maternal mortality rate which stood at 8.8/100,000 live births. The physicians knew all the details in 66 maternal deaths. They identified substandard factors in 57% of these cases. Most of the cases associated with substandard care were women with pregnancy induced hypertension (eclampsia). The substandard care factors included patient or physician's delay, wrong diagnosis, insufficient knowledge of proper treatment, operating without knowledge of clotting disorders, interventions on patients in an unstable condition, inadequate postpartum and postoperative surveillance, and lack of organization. The leading direct cause of maternal death was eclampsia (34%) then thromboembolism (21%), and obstetric hemorrhage (19%). 41% of the women who died from eclampsia also suffered from cerebrovascular hemorrhage. Only 2 women died from septic abortion. The major indirect cause of maternal death was cerebrovascular hemorrhage (57%). Among the direct maternal deaths, 52% had disseminated intravascular coagulation and 25% had a cesarean section. As recently as 1935 in developed countries, puerperal sepsis was the leading cause of maternal deaths (50%) then obstetrical hemorrhage and eclampsia (25%). Mortality rates began to fall with the introduction of sulphonamides and later penicillin. In developing countries, however, maternal mortality remains very high. High rates are due to high fertility and a high risk of death each time a woman is pregnant. Availability of safe contraception and elimination of illegal abortions would reduce maternal mortality considerably.
Authors:
N W Schuitemaker; J B Gravenhorst; H P Van Geijn; G A Dekker; P W Van Dongen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  42 Suppl     ISSN:  0301-2115     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  1991 Dec 
Date Detail:
Created Date:  1992-05-27     Completed Date:  1992-05-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  S31-5     Citation Subset:  IM; J    
Affiliation:
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Cause of Death
Developing Countries
Female
Humans
Maternal Mortality / trends*
Netherlands
Pregnancy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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