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[1]. However, most of these deaths have been medically preventable for decades, as treatments to avoid such deaths have been well-known since the 1950s.
Contents
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 (childbed fever), amniotic fluid embolism, uterine rupture and complications of unsafe or unsanitary abortions. Lesser known causes of maternal death include renal failure, cardiac failure, and hyperemesis gravidarum.
As stated by the 2005 World Health Organization 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,[2] HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.
Forty-five percent of postpartum deaths occur within 24 hours.[3] Over 90% of maternal deaths occur in developing countries. In comparison, pregnancy-associated homicide accounts for 2 to 10 deaths per 100000 live births, possibly substantially higher due to underreporting.[4]
In developed countries, the most common cause of maternal death is obstetrical hemorrhage, followed by deep vein thrombosis.[5]
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.[6] Lowest rates included Ireland 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.[7] This rose to 13.3 per 100,000 in 2006.[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).
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 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 proper staff and equipment such as ones in the Guatemalan highlands.[9]
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 very high levels 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 in 2005 in the United States is 11 in 100,000, a decline by two orders of magnitude,[7] although that figure has begun to rise in recent years, having nearly tripled over the past decade in California.[11] For the United States, 11 in 100,000 is one of the lowest estimates. Maternal deaths in the United States range up to 17 per 100,000 live births[12]. For all reported rates and statistics visit WomanStats.org.
The decline in maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, prevention of unintended pregnancy, 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.[13]
See also
- Endometritis
- List of women who died in childbirth
- Maternal health
- Maternal near miss
- Perinatal mortality
- Puerperal fever
- Reproduction
- Reproductive health
- Stillbirth
- Unintended pregnancy
- Maternal mortality in fiction
References
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ The commonest causes of anaemia are poor nutrition, iron and other micronutrient deficiencies, malaria, hookworm and schistosomiasis (2005 WHO report p45).
- ↑ Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Ob Gyn. 1: 77–81.
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ Venös tromboembolism (VTE) - Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
- ↑ Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June 2008.
- ↑ 7.0 7.1 Maternal Mortality in 2005, accessed on 08-30-2008
- ↑ [1], accessed March 15, 2010
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
- ↑ 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
- ↑ UN Statistical Database, http://unstats.un.org/unsd/default.htm
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
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
