Clear definitions of maternal mortality must be made so that we can compare these rates from different communities/countries. By allowing us to focus on the causes of mortality (especially the common causes), we will be able to reduce the maternal mortality rate.

Important definitions in maternal mortality:

Maternal Mortality rate:

This is the risk of women dying from “puerperal causes”.

= The total no. of female deaths due to complications of pregnancy, childbirth or within 42 days of delivery from “puerperal causes” in an area during a given year/ The total no. of live births in the same area and year

X 1000

The denominator should include all deliveries and abortions.

Ideally the maternal mortality rate should be expressed as a rate per 1000 live births. But lately the multiplying factor of 100000 is used .This is because of the recent decline in the maternal mortality rate in developed countries. This helps avoids fractions.

Definition of  Maternal Death by W.H.O

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 pregnancy,from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Direct and indirect obstetric deaths:

The ICD (International classification of diseases) has recommended that maternal deaths should be classified into direct and indirect deaths.

i) Direct obstetric deaths:

These are deaths resulting from obstetric complications of the pregnant state (pregnancy,labour and puerperium), from interventions,omissions, incorrect treatment, or from a chain of events resulting from any of the above.

ii) Indirect obstetric deaths:

These are deaths resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.

Late maternal death:

A late maternal death is death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.

Fortuitous death:

Deaths from unrelated causes that may happen in pregnancy or puerperium.

The death certificate must include questions regarding current pregnancy and pregnancy within one year preceding death. This will help improve the quality of data on maternal mortality. This recommendation was made by the 43rd World Assembly in 1990.

The incidence of maternal mortality in different countries:

In the whole world there were 536,000 maternal deaths in 2005. That is an average Maternal Mortality Rate (MMR) of 400 per 100,000.

In the developing countries , the average MMR is as high as 960 per 100,000, an exception being Sri Lanka with a MMR of 58 per 100,000.

Comparism of Maternal Mortality in 1990 and 2005 by regions

maternal-mortality-regional-comparism

Maternal mortality rates are highest in Africa. In some parts of rural Africa it may be higher than 1000 per 100,000 live births.

In developed countries the maternal mortality rate is around 9 per 100,000.

Most maternal deaths are preventable (See my article on causes and prevention of maternal mortality).

References:

WHO- Maternal Mortality in 2005

Maternal mortality ,pages 20 to 27. Chapter 3.Obstetrics by Ten Teachers. 17th Edition. Edited by Stuart Campbell and Christoph Lees.

Pages 387 to 389. Maternal Mortality Rate.Chapter 9.Preventive Medicine in Obstetrics,Paediatrics and Geriatrics.Park’s Textbook of Preventive and Social Medicine by K. Park. 17th Edition.

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