Maternal death 354076 225181098 2008-07-12T09:14:24Z 76.185.26.47 typos {{DiseaseDisorder infobox | Name = Maternal death | ICD10 = O95 | ICD9 = {{ICD9|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 country|developed world]]. However, most of these deaths have been [[prevention (medical)|medically preventable]] for decades, because treatments to avoid such deaths have been well known since the 1950s. == Maternal Mortality definition == According to the [[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 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 (1), 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 (2). ==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]], [[amniotic fluid embolism]], and complications of [[abortion]]s. Lesser known causes of maternal death include renal failure, cardiac failure, and brain damage caused by hyperemesis gravidarum. As stated by the 2005 [[WHO]] 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]], [[HIV/AIDS]] and [[cardiovascular disease]], complicate pregnancy or are aggravated by it. Complications of [[Hyperemesis]] Gravidarum also lead to maternal death. ==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.<ref>[http://www.cahr.info/index_files/page0023.htm Maternal Mortality in Central Asia], [[Central Asia Health Review]] (CAHR), 2 June, 2008.</ref> Lowest rates included [[Iceland]] at 0 per 100,000 and [[Austria]] at 4 per 100,000. In the [[United States]], the maternal death rate was 17 maternal deaths per 100,000 live births in 2000. "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 [[World Health Organization|WHO]], [[UNICEF]] and [[UNFPA]] produced a report with statistics gathered from [[2000]]. The world average 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 increases the risk of maternal death from [[cardiovascular disease]]. Subtracting one pound of infant birth weight doubles the risk of maternal death. Therefore, the heavier the birth weight of child, the lower the risk of maternal death. ==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<ref>See for instance mortality rates at the Dublin Maternity Hospital [[Historical mortality rates of puerperal fever#Yearly patient mortality rates at the Dublin Maternity Hospital 1784-1849|1784-1849]]</ref>. Mortality rates reached [[Historical mortality rates of puerperal fever|horrible proportions]] 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 today in the [[United States]] is 13 in 100,000, a decline by orders of magnitude. The decline in maternal deaths has been due largely to improved [[asepsis]], use of [[caesarean section]], fluid management and [[blood transfusion]], and better [[prenatal care]].{{Fact|date=June 2008}} ==See also== *[[List of women who died in childbirth]] *[[Perinatal mortality]] *[[Reproduction]] *[[Reproductive health]] *[[Stillbirth]] ==Notes== <references/> ==References== # [http://www.cahr.info/index_files/page0023.htm Maternal Mortality in Central Asia], [[Central Asia Health Review]] (CAHR), 2 June, 2008. # Lisa M. Koonin, M.N., M.P.H. Hani K. Atrash, M.D., M.P.H. Roger W. Rochat, M.D. Jack C. Smith, M.S. Maternal Mortality Surveillance, United States, 1980-1985 MMWR 12/1/1988; 37(SS-5):19-29. [http://www.cdc.gov/mmwr/preview/mmwrhtml/00001754.htm] # Deneux-Tharaux D, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. Underreporting of Pregnancy-Related Mortality in the United States and Europe. Obstet Gynecol 2005;106:684-92. ==External links== * [http://www.cahr.info/index_files/page0023.htm Maternal Mortality in Central Asia], [[Central Asia Health Review]] (CAHR), 2 June, 2008. * [http://www.who.int/reproductive-health/publications/maternal_mortality_2000/index.html Maternal Mortality Estimates 2000 by the WHO & UNICEF] * [http://www.who.int/whr/2005/en/ The World Health Report 2005 – Make Every Mother and Child Count] * [http://www.cemach.org.uk/Home.aspx Confidential Enquiry into Maternal and Child Health (CEMACH)] - UK triennial enquiry into "Why Mothers Die" * [http://www.wilsoncenter.org/index.cfm?topic_id=116811&fuseaction=topics.event_summary&event_id=394874 Reducing Maternal Mortality in Developing Countries] - Video, presentations, and summary of event held at the Woodrow Wilson International Center for Scholars, March 2008 <!-- http://www.wikigender.org/wiki/index.php?title=WomanStats_Database WomanStats Database] - Provides maternal mortality data disaggregated by country. --> {{Pathology of pregnancy, childbirth and the puerperium}} [[Category:Death]] [[Category:Deaths in childbirth]] [[Category:Obstetrics]] [[Category:Medical terms]] [[Category:Demography]]