The pathology of maternal mortality

Article Abstract:

This extensive article provides a complete review of the pathology of maternal mortality based on the conditions in the authors' 20 year experience (1966 to 1985) that led to maternal death. Two hundred eighty-one cases are reviewed. The term 'lesion' is used to represent abnormalities of structure or chemical function. Lesions not directly due to pregnancy may be the result of conditions already present that are enhanced by pregnancy; of disorders for which pregnancy is a minor enhancer; or of disorders that simply happen to occur in the pregnant woman. Each category of disorder is further subdivided into particular diseases, the pathology of which are described with illustrative data from case histories. Maternal death is defined as death during childbirth or immediately after the products of conception have been removed, or death up to 120 days after the placental sac, embryo, fetus, or infant is passed. In formulating this definition, the authors differ from the American College of Obstetricians and Gynecologists. The latter group has limited the definition in several ways, but the authors of this article believe that, since the contribution of pregnancy to the effects of other diseases is often not known, the best definition is one that temporally links pregnancy and death. For instance, accidents or homicides are included because psychological factors related to pregnancy could have been involved. Improvements in medical and prenatal care mean that a greater proportion of maternal deaths will occur after discharge. The perinatal mortality (infant death after the 28th gestational week or during the four weeks after delivery) for this group was 32.7 percent, three quarters of which were stillborn. Each maternal death needs careful and intensive study. Autopsies should be performed in all cases as a first step in improving the understanding of the causes of maternal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnant women

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Umbilical vein administration of oxytocin for the management of retained placenta: is it effective?

Article Abstract:

Following a vaginal delivery, retention of the placenta sometimes occurs. This condition poses health risks to the mother, particularly hemorrhage and infection. Because manual removal of the placenta is associated with the risk of incomplete removal and other problems, researchers have sought to develop a safe and reliable method of removing a retained placenta. The pituitary hormone oxytocin causes contraction of the uterus and thereby induces childbirth. Previous studies have reported that the injection of oxytocin into the umbilical vein causes expulsion of the retained placenta within minutes. (The umbilical vein passes through the umbilicus, which provides oxygen and nourishment to the fetus. After childbirth, the umbilicus is cut at the newborn's end and the placenta is usually spontaneously expelled as the uterus contracts.) The effectiveness of umbilical vein administration of oxytocin for managing retained placenta was assessed. Ten international units (IU) of oxytocin in 20 milliliters of saline, or physiological salt solution, was injected into the umbilical veins of 220 women with retained placentas. This technique did not provide any beneficial effects and did not reduce the rate of manual removal of the retained placenta or the volume of blood loss. When compared with saline injection alone, oxytocin reduced the period between umbilical vein injection and expulsion of the retained placenta. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Dosage and administration, Placenta, Pregnancy, Complications of, Pregnancy complications, Oxytocin

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Maternal mortality: Confidential Enquiries into Maternal Deaths in the United Kingdom

Article Abstract:

Maternal death following childbirth in the UK has fallen from 70 cases per 100,000 births in the 1950s to 11 per 100,000 births in the 1990s. The leading causes of death are hypertension, abnormal blood clotting, miscarriage, hemorrhage, amniotic fluid embolism, and genital tract infection. Indirect causes include heart or endocrine disease.

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