This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.
To determine the antecedent factors, morbidity, and mortality associated with disseminated intravascular coagulation (DIC) in a Nova Scotia tertiary maternity hospital over a 30-year period.
Cases of DIC were identified from the Nova Scotia Atlee Perinatal Database for the years 1980 to 2009 and the hospital charts reviewed. The clinical diagnosis of DIC was confirmed or refuted using a combination of the International Society of Thrombosis and Haemostasis scoring system and an obstetrical DIC-severity staging system. The cause of DIC was determined from chart review. Maternal outcomes included massive transfusion (= 5 units), hysterectomy, admission to ICU, acute tubular necrosis (ATN) requiring dialysis, and death. Neonatal outcomes included Apgar scores, birth weight, NICU admission, and death. Treatment of DIC was assessed by blood products administered, postpartum hemorrhage management, and laboratory measurements.
There were 49 cases of DIC in 151 678 deliveries (3 per 10,000) over the 30 years. Antecedent causes included placental abruption (37%), postpartum hemorrhage or hypovolemia (29%), preeclampsia/HELLP (14%), acute fatty liver (8%), sepsis (6%), and amniotic fluid embolism (6%). The associated maternal morbidity included transfusion = 5 units (59%), hysterectomy (18%), ICU admission (41%), and ATN requiring dialysis (6%). There were three maternal deaths, giving a case fatality rate of 1 in 16. The perinatal outcomes included stillbirth (25%), neonatal death (5%), and NICU admission (72.5%).
Obstetrical DIC is an uncommon condition associated with high maternal and perinatal morbidity and mortality. Prompt recognition and treatment with timely administration of blood products is crucial in the management of this life-threatening disorder.
In this retrospective cohort of 165,188 singleton pregnancies and 44,674 multiple-fetal pregnancies in Canada from 1984 to 2000, we compared the incidence of maternal complications. Multiple gestation pregnancies were associated with significant increases in cardiac morbidity, haematologic morbidity, amniotic fluid embolus, pre-eclampsia, gestational diabetes, postpartum haemorrhage, prolonged hospital stay, the need for obstetric intervention, hysterectomy and blood transfusion. Multiple gestation pregnancies are associated with an increased risk of morbidity for the mother. This should be taken into consideration in antenatal care of these women.
The University of Zimbabwe and two universities in Sweden conducted a study in Masvingo Province in Zimbabwe to examine maternal deaths. There were 168 and 85 maternal deaths per 100,000 live births in rural and urban areas, respectively. 90% and 85% of maternal deaths in rural and urban areas, respectively, were preventable. Mother-related preventable factors were no prenatal care, lack of social support, and delay in seeking help. Traditional birth attendant-related preventable factors were delay in referring mother to health care, inability to understand the severity of the complication, and administration of the wrong treatment. Local clinic-related preventable factors included inadequate resources, poor communication, and poor training of health care staff. Hospital-related preventable factors were delayed treatment, wrong diagnosis, wrong treatment, no supplies, and inadequate skills. Lack of prenatal care was common among many women who died from pregnancy- or childbirth-related complications. More than 33% of maternal deaths in rural areas occurred because there were no means for transport to the nearest clinic or hospital. Women who were single, divorced, separated, or self-supporting during pregnancy were more likely to die due to lack of social support. Other risk factors were high rate of unwanted pregnancies, age 35 or above, previous fetal death or miscarriage, and parity 7 or above. The leading causes of maternal death in rural areas included hemorrhage (25%), sepsis after unsafe abortion (15%), and puerperal sepsis (13%). In urban areas, they were eclampsia (26%), sepsis after unsafe abortion (23%), puerperal sepsis (15%), and hemorrhage (10%). 50% of the maternal deaths occurred outside of a health facility. More than 50% had already delivered 5 times. Recommendations to reduce maternal deaths were community-based health education on the risk factors of pregnancy and childbirth, improved health facilities, better training of health personnel, and improved family planning programs.
The present analysis of maternal and infant (under 1 year of age) mortality is based on the data for the period from 2002 to 2006 that have come to the address of the All-Russia scientific and practical conference "Topical issues of forensic medical examination of the human corpse" (5-6 June 2008, Sankt-Peterburg). The materials were collected using a standard questionnaire form distributed among regional forensic-medical examination bureaus an pathologic anatomy departments. The questionnaire comprised over 50 questions. The study revealed a steady tendency toward a decrease in maternal and infant mortality in the Russian Federation as a whole and in its different regions. The study included analysis of similarities and differences in the mortality rates reported by forensic-medical examination bureaus and pathologic anatomy departments of the country and in the technical approaches practiced by them.
There were 132 maternal deaths in British Columbia in the years 1963 to 1970. The mean maternal mortality rate for these eight years was 0.317. Sixty of these deaths (45.5%) were due to direct obstetrical causes. Indirect and nonrelated deaths accounted for 21.2 and 33.3% of the total, respectively. The most common causes of direct obstetrical deaths were hemorrhage, infection and vascular accidents, in that order; pre-eclampsia ranked a distant fourth. Ninety-five percent of direct obstetrical deaths were probably avoidable. Approximately 27% of all direct obstetrical deaths were abortion-related. Hemorrhage continues to be a major problem, in particular among the native Indian women of the province.If further reduction in maternal mortality is to be achieved, obstetrical hemorrhage must be better managed and deaths due to abortions reduced. Future studies should reveal if the liberalized abortion laws will assist in the realization of the latter goal.
Cites: Can Med Assoc J. 1965 Jan 23;92:160-7014232190