Maternal death
| Maternal death | |
|---|---|
| Classification and external resources | |
| ICD-10 | O95 |
| ICD-9 | 646.9 |
According to the World Health Organization (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 management of the two, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.
The U.S. Joint Commission on Accreditation of Healthcare Organizations calls maternal mortality is a "sentinel event", and uses it 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 only 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.
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[edit] Major causes
As stated by the WHO in its 2005 World Health Report "Make Every Mother and Child Count", the major causes of maternal deaths 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 are things such as malaria, anaemia,[3] HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.
Forty-five percent of postpartum deaths occur within 24 hours.[4] Over 90% of maternal deaths occur in developing countries. In comparison, pregnancy-associated homicide accounts for 2 to 10 deaths per 100,000 live births, possibly substantially higher due to underreporting.[5]
In developing countries, the most common cause of maternal death is obstetrical hemorrhage, followed by deep vein thrombosis, in contrast to developed countries, for which the most common cause is thromboembolism.[6]
Unintended pregnancy is a major cause of maternal deaths. Worldwide, unintended pregnancy resulted in almost 700,000 maternal deaths from 1995 to 2000 (approximately one-fifth of the maternal deaths during that period).[7] The majority (64%) resulted from complications from unsafe or unsanitary abortion.[7]
[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 lack of access to skilled medical care during childbirth and the distance of traveling to the nearest clinic to receive proper care. In developing nations, 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 qualified staff and equipment such as ones in the Guatemalan highlands.[8]
[edit] Maternal Mortality Numbers
The World Health Organization estimates that approximately 1,000 women globally die every day due to complications from pregnancy or delivery[World Health Organization 1]. The number of maternal deaths worldwide was estimated to be 529,000 in 2000[United Nations 1]. However, it is well recognized that maternal mortality numbers are often significantly under reported.[9] In fact, according to the United Nations, it is estimated that the numbers of maternal deaths globally could fall within a range of 277,000 to 817,000 per year[United Nations 2].
Africa and Asia account for 95% of the maternal deaths each year. Those deaths are evenly divided between the two regions. Latin America and the Caribbean account for 4% of maternal deaths, and the remaining 1% is found in developed regions of the world[United Nations 3].
[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.[10] Lowest rates included Ireland at 0 per 100,000[citation needed] 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.[11] This rose to 13.3 per 100,000 in 2006.[12] "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. Countries with highest maternal mortality 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] International Community Reaction
Reducing the maternal mortality by three quarters between 1990 and 2015 is the first target of Goal 5 -Improving Maternal Health - of the eight Millennium Development Goals; its progress is monitored at mdgmonitor.org[13]
Proportionally, aid given to improve maternal mortality rates has shrunk as other public health issues, such as HIV/AIDS, have become major international concerns. This can be viewed at [2]. Maternal health aid contributions tend to be lumped together with newborn and child health, so it is difficult to assess how much aid is given directly to maternal health to help lower the rates of maternal mortality. Regardless, there has been progress in reducing maternal mortality rates internationally as can be viewed [3].
[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.[14] Mortality rates reached very high levels in maternity institutions in the 1800s, sometimes climbing to 40 percent of birthgiving women (see Historical mortality rates of puerperal fever). At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births.[citation needed] The number in 2005 in the United States was 11 in 100,000, a decline by two orders of magnitude,[11] although that figure has begun to rise in recent years, having nearly tripled over the decade up to 2010 in California.[15] A maternal mortality rate for the U.S. of 24 per 100,000 was reported for 2008.[16] This change might not actually reflect an increase, due to a change in reporting methods by the CDC in 1999.[17]
The decline in maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care.[citation needed] Recommendations for reducing maternal mortality include access to health care, access to family planning services, and emergency obstetric care, funding and intrapartum care.[18] Reduction in unnecessary obstetric surgery has also been suggested.
[edit] See also
- Endometritis
- List of women who died in childbirth
- Maternal health
- Maternal near miss
- Obstetrical Dilemma
- Perinatal mortality
- Puerperal fever
- Reproduction
- Reproductive health
- Stillbirth
- Unintended pregnancy
- Maternal mortality in fiction
- Global Library of Women's Medicine
[edit] References
- ^ Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June 2008
- ^ Koonin, Lisa M.; Hani K. Atrash, Roger W. Rochat, Jack C. Smith (1 December 1988). "Maternal Mortality Surveillance, United States, 1980–1985". MMWR 37 (SS-5): 19–29. PMID 3148106. http://www.cdc.gov/mmwR/preview/mmwrhtml/00001754.htm.
- ^ The commonest causes of anaemia are poor nutrition, iron and other micronutrient deficiencies. These things in addition to malaria, hookworm and schistosomiasis (2005 WHO report p45).
- ^ Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Ob Gyn 1: 77–81.
- ^ Horon IL, Cheng D (November 2005). "Underreporting of pregnancy-associated deaths". Am J Public Health 95 (11): 1879; author reply 1879–80. DOI:10.2105/AJPH.2005.072017. PMC 1449445. PMID 16195505. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1449445.
- ^ Venös tromboembolism (VTE) - Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
- ^ a b Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World. http://www.globalhealth.org/news/article/2319. Retrieved 2009-01-22.
- ^ 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. PMID 8042057.
- ^ 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 (4): 684–692. DOI:10.1097/01.AOG.0000174580.24281.e6. PMID 16199622.
- ^ Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June 2008.
- ^ a b Maternal Mortality in 2005, accessed on 08-30-2008
- ^ [1], accessed March 15, 2010
- ^ Monitor of Goal 5 of the Millennium Development Goals, accessed on 08-26-2008
- ^ See for instance mortality rates at the Dublin Maternity Hospital 1784–1849
- ^ Maternal Mortality Rates Rising in California ABC News Retrieved on March 4, 2010
- ^ MMR from CIA factbook
- ^ http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf Maternal Mortality and Related Concepts Vital Health Statistics, February 2007
- ^ Costello, A; Azad K, Barnett S (2006). "An alternative study to reduce maternal mortality". The Lancet 368 (9546): 1477–1479. DOI:10.1016/S0140-6736(06)69388-4.
- ^ "Maternal and Reproductive Health". http://www.who.int/gho/maternal_health/en/index.html. Retrieved 4 March 2012.
- ^ Department of Economic and Social Affairs, Statistics Division. "Progress towards the Millennium Development Goals, 1990-2015". http://unstats.un.org/unsd/mi/goals_2005/goal_5.pdf. Retrieved 4 March 2012.
- ^ Department of Social and Economic Affairs, Statistics Department. "Progress Towards the Millennium Development Goals Goal Five: Improve Maternal Health". http://unstats.un.org/unsd/mi/goals_2005/goal_5.pdf. Retrieved 4 March 2012.
- ^ Department of Economic and Social Affairs, Statistics Division. "Progress towards the Millennium Development Goals, 1990-2005". http://unstats.un.org/unsd/mi/goals_2005/goal_5.pdf. Retrieved 4 March 2012.
[edit] External links
- Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June 2008.
- Maternal Mortality Estimates 2000 by the WHO & UNICEF
- 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
- Birth of a Surgeon PBS documentary about midwives trained in surgical techniques in Mozambique
- Save A Mother Non-profit focused on MMR reduction.
- The Global Library of Women's Medicine Safer Motherhood Section - non-profit offering freely downloadable material for healthcare professionals
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