| 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 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 (down from 526,300 in 1980), 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.
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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."[2]
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,[3] 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.[4]
Reducing the maternal mortality by three quarters between 1990 and 2015 is a specific part of Goal 5 -Improving Maternal Health - of the eight Millennium Development Goals; its progress is monitored at mdgmonitor.org[5]
As stated by the WHO in its 2005 World Health 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,[6] HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.
Forty-five percent of postpartum deaths occur within 24 hours.[7] 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.[8]
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.[9]
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).[10] The majority (64%) resulted from complications from unsafe or unsanitary abortion.[10]
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.[11] 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.[12] This rose to 13.3 per 100,000 in 2006.[13] "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).
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.
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.[14]
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.[15] 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 was 11 in 100,000, a decline by two orders of magnitude,[12] although that figure has begun to rise in recent years, having nearly tripled over the decade up to 2010 in California.[16] A maternal mortality rate for the U.S. of 24 per 100,000 was reported for 2008.[17] The increase may be due to a change in reporting methods by the CDC in 1999. [18]
The decline in maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care. Recommendations for reducing maternal mortality include access to health care, access to family planning services, and emergency obstetric care, funding and intrapartum care.[19]
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