, or '''maternal mortality''', also "obstetric death" is the
Death of a woman in relation to a
Pregnancy . In 2000, the
United Nations estimated global maternal mortality at 529,000, of which less than 1% occurred in the
Developed World . However, most of these deaths have been
Medically Preventable for decades, because treatments to avoid such deaths have been well known since the 1950s.
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 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% 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).
The major causes of maternal death are bacterial
Infection ,
Toxemia ,
Obstetrical Hemorrhage ,
Ectopic Pregnancy ,
Puerperal Sepsis ,
Amniotic Fluid Embolus , and complications of
Abortion s.
As stated by the 2005 (12%), obstructed labour (8%), complications of abortion (13%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggrevated by it.
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. 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.
The MMR for each country is listed here:
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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.
The death rate for women giving birth plummeted in the 20th century.
At the beginning of the century, maternal death rates were around their historical level of nearly 1 in 100 for live births. The number today in the
United States is 1 in 10,000, a 99% decline.
The decline in maternal deaths has been due largely to improved asespsis, use of cesarian section, fluid management and blood transfusion, and better
Prenatal Care .
# 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.
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# 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.
