A 10-year review of maternal mortality in a municipal hospital in Rio de Janeiro: a cause for concern

Article Abstract:

The vast majority (98 percent) of maternal deaths related with childbearing occur in the developing world; most are preventable. In Brazil, where a discrepancy between hospital and official records exists, and where it is believed that improvements in maternal mortality are less than have been reported, a 10-year review of maternal deaths in one busy municipal hospital (located in Rio de Janeiro) was carried out. The study encompassed the period from January 1978 through December 1987. In the 48-bed maternity ward, 11 beds are set aside for patients suffering from complications of abortions, a procedure that is prohibited. Patients' records were reviewed to determine the number of women who died in the maternity, gynecologic, surgical, and intensive care units. Causes of death were rated as direct (resulting directly from an obstetrical event) or indirect (from illness or disease not directly related to an obstetric event, such as cardiac disease). Results showed that 32 maternal deaths, and 18,071 live births, had been recorded during the study period, giving an overall maternal mortality ratio of 177 maternal deaths per 100,000 live births. Mortality from direct causes greatly exceeded that from indirect causes. Between 1978 and 1987, however, the ratio rose from 128 to 462 maternal deaths per 100,000 live births (a 268 percent increase), due primarily to deaths related to abortion. Abortion was responsible for 15 of the 32 deaths; the next highest cause was toxemia (a condition associated with high blood pressure), which led to 6 deaths. Forty percent of all admissions to the maternity ward were for treatment of abortion-related complications. The population served by this hospital is urban and poor; almost none of the women had received prenatal care. Abortion-related maternal mortality is known to increase in direct relationship to the restrictiveness of a country's abortion policy. Brazil now allows women to avail themselves of contraceptive services; however, implementation of this governmental sanction is minimal. If the US Supreme Court reverses its current policy and prohibits abortion, mortality from illegal abortions will increase in the US. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Causes of, Complications and side effects, Brazil, Childbirth, Delivery (Childbirth), Abortion

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Maternal mortality in New York City, 1981-1983

Article Abstract:

To learn more about maternal mortality in New York City, a place where AIDS is now the leading cause of death for women of childbearing age, the death certificates of all women who died between January 1, 1981, and December 31, 1983 in New York City were reviewed. The data were collected to provide a baseline picture of maternal mortality, against which the more recent impact of AIDS could be evaluated in the future. Medical records and autopsy reports for deaths that were apparently related to pregnancy were reviewed by an obstetrician. Demographic characteristics of the mother, as well as the circumstances surrounding her pregnancy, delivery, and death, were noted. Results showed that, when strict criteria were used for defining pregnancy-related deaths, maternal mortality was 36.1 deaths per 100,000 live births, representing a total of 120 maternal deaths during the period covered. Eight maternal deaths occurred more than 42 days after the end of pregnancy; if these were excluded (as is often done when mortality is calculated), mortality would have been 33.7 per 100,000 live births. Fifteen percent of the women who died were non-Hispanic whites, while 55 percent of the women were black and 27 percent were Hispanic. The risk of death increased with maternal age, and rose especially rapidly after age 40. A little more than half the deaths were considered direct maternal deaths (from obstetrical complications or interventions), while the rest were indirectly related to maternity (from previously existing disease or a disease that developed during pregnancy). The leading cause of death was ectopic pregnancy, in which the fetus develops outside the uterus. Extensive details are provided regarding additional causes of death. Maternal mortality in other developed countries ranges between 7 and 15 per 100,000 live births; thus New York City exceeds that rate, and the study probably has underreported the true frequency. Attention should be paid to accurate, careful recording of the causes of maternal death, so that these untimely events can serve a purpose in helping to prevent future maternal deaths. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications

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Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991

Article Abstract:

Homicide and injuries may be significant causes of death among pregnant women, especially in urban areas. Researchers reviewed the records of the New York City medical examiner to relate the incidence of pregnancy and cause of death among 2331 women ages 15 to 44. Autopsy information established that 293 women in the group were pregnant or had recently been pregnant at the time of death. This number may be an underestimate. Injury was the cause of death for 115 (39%) of the 293 pregnant women. Of the 115, 63% of the injury deaths were listed as homicides. Younger women in the earlier stages of pregnancy and black pregnant women had increased risks of homicide death. Prenatal and postpartum visits should be used to identify and help women at risk of abuse.

Cases, Wounds and injuries, Injuries, Homicide

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