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Correlates of Abortion Related Maternal Mortality at the Lagos State University Teaching Hospital, Ikeja
AO Fabamwo, OI Akinola, AE Akpan
African Journal of Reproductive Health , 2009,
Abstract: This study was carried out to highlight the probable correlates of mortality among patients managed for abortion related complications at the Lagos State University Teaching Hospital, Ikeja. All patients managed for abortion related complications between 1st January 2000 and 31st December 2003 were studied. Certain relevant socio demographic and clinical factors were compared among the survivors and fatalities. There were a total of 338 patients with abortion related complications. 299 survived while 39 died. Being single, nulliparous, of low educational status, presenting late and having major complications were significantly associated with mortality in this series. Encouragement of safe sex practices, increasing adolescents’ access to contraception, additional training of physicians and other appropriate heath workers in abortion care as well as the liberalisation of the restrictive abortion laws in Nigeria will go a long way in reducing abortion related mortality (Afr J Reprod Health 2009; 13[2]:139-146).
The Professional Medical Journal , 2009,
Abstract: Objective: To find out maternal mortality ratio (MMR) and to determine major causes of maternal death. Study design: A descriptive study. Setting: Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. Study period: From 01.01.2008 to 31.12.2008. Materials and methods: All cases of maternal death during this study periods were included except accidental deaths. Results: There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births. The most common cause of maternal death was hemorrhage (34.5%) followed by hypertensive disorders/eclampsia (31%). Most of the patients (75.86%) were referred from primary & secondary care level. Conclusion: Maternal mortality is still very high in underdeveloped countries including Pakistan. We must enhance emergency obstetric care (EOC) to achieve the goal of reduction in MMR.
Autopsy as a tool in the prevention of maternal mortality
A.O Daramola, A.A.F Banjo
Nigerian Journal of Clinical Practice , 2009,
Abstract: Maternal mortality rates are an index of the state of a nation's health system. Maternal autopsies help to determine these rates, provide information on avoidable/unavoidable causes of mortality, consequently leading to the development of strategies for treatment and prevention ofmaternalmortality andmorbidity. The lesson from post-mortem examinations, using the vehicle of confidential enquiries into maternal deaths, can save the lives of many; causing reduction in both maternal and perinatal mortality as well as reductions in morbidity. However for autopsies to fulfil this role they must be of a very high standard and must be subjected to quality controlmeasures.
The Professional Medical Journal , 2010,
Abstract: To estimate maternal mortality ratio (MMR), obstetrical causes and determinants of maternal mortality. StudyDesign: A descriptive study. Place & Duration of Study: The study was conducted in Obstetrics & Gynaecology Department at BahawalVictoria Hospital, affiliated with Quaid-e-Azam Medical College, Bahawalpur. This was a 3 years study conducted from January 2006 toDecember 2008. Patients & Methods: All direct and indirect maternal deaths during pregnancy, labor and perpeurium were included. Thepatients who expired after arrival were analyzed on specially designed Performa from their hospital records and questions asking from theirattendants. The reason for admission, condition at arrival, cause of death and possible factors responsible for death were identified. The otherinformation including age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospitalwas recorded on Performa and analyzed by SPSS version 11. Results: There were a total of 21501 deliveries and 19462 live births with 2039peri-natal moralities. Total 133 maternal deaths occurred during last 3 consecutive years revealed MMR 683 per 100000 live births. Majority ofthe women who died were un-booked (91%). The highest maternal mortality age group was 20-30 years in which 54.2% deaths were observed.Out of 133 maternal deaths, 21% were primigravida. Obstetrical hemorrhage (44.4%) was the most frequent cause followed by hypertensivedisorders (21.8%) & sepsis (15%). There were 33.8% of patients who were brought at compromised stage and 52.6% brought critical, only13.5% died were stable at the time of arrival at hospital. Conclusions: Obstetrical haemorrhage was the leading cause of maternal deaths. Thisdreadful cause is preventable and manageable if steps are taken in time during antenatal period for risk detection and in postnatal period.Community awareness, training of traditional birth attendants to recognize the severity of disease and importance of being in time and improvingreferral can reduce the maternal deaths.
The Professional Medical Journal , 2009,
Abstract: Objective: The women residing in a developing country have 200 times greater risk of suffering from pregnancy and childbirth related mortality compared with the women of a developed country. To investigate relevant causes and the determinants of maternal mortality through conducting scientific clinical studies. Methodologies: We conducted a prospective study of maternal deaths in the obstetrics and gynaecology unit of RGH for one year. Period: January 2007 to December 2007. We investigated the socio-demographic variables -- including age, parity, socio-economic status and literacy -- along with the social behavior towards the antenatal. We designed standardized data collecting forms to collect data from the confidential hospital notes of the patients. The collected medical data of the patients proved useful in analyzing the underlying causes and the risk factors behind direct and indirect maternal mortalities. Results: In our unit, we have recorded 28 maternal deaths during the study period. 24 (86%) deaths are due to the direct causes and 4 (14%) are due to the indirect causes. The leading direct causes are hemorrhage 9 (37.5%), eclampsia 7 (29%), septicemia 5 (21%) and anaesthesia complications 2 (8%). Similarly, the distribution of indirect causes is: blood transfusion reactions 2 (50 %), hepatic failure 2 (50 %), Consequently, crude maternal mortality rate can be extrapolated at 645 per 100,000 maternities and maternal mortality ratio at 659 per 100,000 live births. The socio demographics of the dead mothers are: 16 (57%) patients in the age group of 25-35 years, 13 (52%) are multiparas (G2-G4) and 10 (36%) are grandmulti para i.e. G5 and above. Moreover, 13 (46%) of them expired at term. The majority of them is illiterate and belongs to lower socio-economic group. 14 (42%) mothers have not received antenatal care and just 4 (15%) of them have received antenatal care from RGH or other hospital. 23 (92%) patients have been suffering from anemia and we received 15 (54%) of them in a critical state with the hospital stay of less than 12 hours. Conclusion: In our study hemorrhage and hypertensive disorders of pregnancy are the leading causes of maternal deaths. We argue that most of these maternal deaths could have been possibly avoided by periodic interventions during the pregnancy, child birth and the postpartum period.
Maternal Mortality Interventions: A Systematic Review  [PDF]
Gina Marie Piane, Eliva Ambugo Clinton
Open Journal of Preventive Medicine (OJPM) , 2014, DOI: 10.4236/ojpm.2014.49079
Abstract: Background: In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: This systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers.
Maternal Mortality Trend in Ethiopia
A Abdella
Ethiopian Journal of Health Development , 2010,
Abstract: Background: Maternal mortality ratio is one of the indicators in the MDG that is raising concern in achieving the set target of reducing the rate by two-third by 2015. Objectives: To review the maternal mortality trend and the causes of maternal deaths in Ethiopia. Methods: Review of published and unpublished documents addressing maternal mortality in Ethiopia. Result: DHS and hospital data indicate decreasing maternal mortality even though the current maternal mortality ratio is still high. The proportion of maternal deaths due to the each of the five major causes varies with time. Generally, the limited information indicates that the proportion of maternal deaths after unsafe abortion is decreasing while deaths after preeclampsia/ eclampsia are increasing. There is no grossly notable change in the proportion of deaths due to ruptured uterus/ obstructed labor, hemorrhage and sepsis. In recent studies, maternal deaths following hepatitis are not reported while deaths due to HIV are appearing. Deaths complicated by malaria are seen in certain parts of the country. The case fatality rates of preeclampsia/eclampsia and ruptured uterus/ obstructed labor are increasing. Conclusion: Even though the review is constrained by inadequate data and interpretation uncertainty of the findings, it generally indicates the urgent need of improving the quality of maternal health services; scaling up evidence based interventions; and measuring progress. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:115-122]
Determinants of Maternal Mortality in Eritrea
M Ghebrehiwet, RH Morrow
Journal of the Eritrean Medical Association , 2008,
Abstract: Objective: This study was undertaken with a general objective of determining the determinants of maternal mortality in Eritrea. Methods: The study was a case control study which compared 50 women whose pregnancies led to death with 50 individually matched women that survived a severe life threatening obstetric complication in the same community. Findings: From the comparison of maternal deaths (cases) and survivors of severe life threatening obstetric complications (controls), seeking medical care on the part of the survivors was significantly more frequent in both bivariate and multivariate analysis than was the case in those who died and was probably protective. Conclusion: The study concluded that seeking medical care was negatively associated with maternal death and was probably protective.
Estimates of maternal mortality for 1995
Hill,Kenneth; AbouZahr,Carla; Wardlaw,Tessa;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001000300005
Abstract: objective: to present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. methods: for countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. rather than estimate the maternal mortality ratio (mmratio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. findings: on the basis of this exercise, we have obtained a global estimate of 515 000 maternal deaths in 1995, with a worldwide mmratio of 397 per 100 000 live births. the differences, by region, were very great, with over half (273 000 maternal deaths) occurring in africa (mmratio: >1000 per 100 000), compared with a total of only 2000 maternal deaths in europe (mmratio: 28 per 100 000). lower and upper uncertainty bounds were also estimated, on the basis of which the global mmratio was unlikely to be less than 234 or more than 635 per 100 000 live births. these uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. conclusion: the mmratio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. it is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.
Maternal mortality: An autopsy audit  [cached]
Jashnani K,Rupani A,Wani R
Journal of Postgraduate Medicine , 2009,
Abstract: Background: The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention. Aims: This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis. An audit of maternal autopsies was carried out to evaluate current practices, identify fallacies and suggest corrective measures to rectify them. Materials and Methods: Eighty-nine autopsies of maternal deaths in the period 2003 to 2007 were studied in detail along with the clinical details. Results: There were 158 maternal deaths and 13940 live births in this five-year period. Maternal mortality rate was found to be very high (1133/ 100000 live births) in our institution with a high number of complicated referral cases (68/89 cases, 76%). Of the 89 autopsies, acute fulminant viral hepatitis was the commonest cause of indirect maternal deaths (37 cases, 41.5%). This was followed by direct causes like pregnancy-induced hypertension (12 cases, 13.4%) and puerperal sepsis (10 cases, 11.2%). Certain fallacies were noted during the audit process. Conclusion: During the audit it was realized that in maternal mortality autopsies, special emphasis should be given to clinicopathologic correlation, microbiological studies, identification of thromboembolic phenomenon and adequate sectioning of relevant organs. We found difficulty in identification of placental bed in the uterus in postpartum autopsies. A systematic approach can help us for better understanding of the pathophysiology of diseases occurring in pregnancy.
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