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Physicians analyzed 1983-88 data on 99 maternal deaths in the netherlands to examine causes of death and to what degree substandard care contributed to the deaths. 65 cases were classified as direct maternal deaths, 14 ad indirect maternal deaths, and 20 as fortuitous maternal deaths. They did not include the 20 fortuitous deaths in the maternal mortality rate which stood at 8.8/100,000 live births. The physicians knew all the details in 66 maternal deaths. They identified substandard factors in 57% of these cases. Most of the cases associated with substandard care were women with pregnancy induced hypertension (eclampsia). The substandard care factors included patient or physician's delay, wrong diagnosis, insufficient knowledge of proper treatment, operating without knowledge of clotting disorders, interventions on patients in an unstable condition, inadequate postpartum and postoperative surveillance, and lack of organization. The leading direct cause of maternal death was eclampsia (34%) then thromboembolism (21%), and obstetric hemorrhage (19%). 41% of the women who died from eclampsia also suffered from cerebrovascular hemorrhage. Only 2 women died from septic abortion. The major indirect cause of maternal death was cerebrovascular hemorrhage (57%). Among the direct maternal deaths, 52% had disseminated intravascular coagulation and 25% had a cesarean section. As recently as 1935 in developed countries, puerperal sepsis was the leading cause of maternal deaths (50%) then obstetrical hemorrhage and eclampsia (25%). Mortality rates began to fall with the introduction of sulphonamides and later penicillin. In developing countries, however, maternal mortality remains very high. High rates are due to high fertility and a high risk of death each time a woman is pregnant. Availability of safe contraception and elimination of illegal abortions would reduce maternal mortality considerably.
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PMID:Maternal mortality and its prevention. 180 6

There were 39 maternal deaths at Harare Hospital during 1987, giving a maternal mortality rate of 122/100,000 live births. If women who lived outside the Harare Municipality were excluded, the maternal mortality rate for the Greater Harare Maternity Unit was 53/100,000 live births. The cases were reviewed at monthly meetings in the Department of Obstetrics and Gynaecology. Hypertensive disease in pregnancy caused 28pc of the deaths with haemorrhage, puerperal sepsis and abortion accounting for 18pc each. Avoidable factors were felt to be present in 88pc of cases and these are discussed.
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PMID:Harare Hospital maternal mortality report for 1987 and a comparison with previous reports. 228 30

A researcher reviewed the January 1984-December 1986 birth and obstetrical records at the University of Nigeria Teaching Hospital in Enugu. During this period, the incidence rate for abruptio placentae was .44% (81/18,215). 56 of these cases were considered mild and 25 were severe. 15/81 cases did not have adequate antenatal care. 49.4% of the cases were in the 26-30 year old age group. The higher the parity of the women the higher the percentage of those with abruptio placentae, e.g., 3.7% for primigravidas and 33.3% for parity or = 5. The leading symptoms included tender uterus (87.7%), abdominal pain (85.2%), and vaginal bleeding (54.3%). Other symptoms included hypertension, shock, and proteinuria. Vaginal delivery accounted for 80.3% of the abruptio placentae births, while cesarean section accounted for 12.4%, vacuum extraction 3.7%, and breech delivery 3.7%. 91.4% of the patients required a blood transfusion with an average of 3 pints of blood/patient. 22.2% of the patients experienced severe postpartum hemorrhage as a result of uterine atony, coagulation failure, or puerperal sepsis. The perinatal mortality rate stood at 58%. None of the 15% of mothers who had severe abruptio placentae had a live infant. 16% of the infants were premature. Since most of the referred patients either did not have any antenatal care or had inadequate antenatal care, it appears that an appropriate measure to reduce the gravity of abruptio placentae would be a wider distribution of excellent antenatal and obstetric management in the rural areas.
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PMID:Abruptio placentae at the University of Nigeria Teaching Hospital, Enugu: a 3-year study. 280 22

Retrospective data from records, reports, and charts were obtained from Chon Buri Hospital in Chon Buri province, Thailand, between January 1982 and December 1991 and analyzed. Maternal mortality was 27 deaths out of 52,805 births in the 10 year period (51.1 per 100,000 live births). Between 1982 and 1988 maternal mortality was 59.8 per 100,000; between 1988 and 1991 the rate was 39.7. Differences are not statistically significant. Nationally the maternal mortality rate declined from 494-1729 50 years ago to 30.9-184.2 in the last 15 years. In 1988 the national maternal mortality rate was 30.9. The age at death ranged from 17 years to 40 years with a mean of 28.7 +or- 7.3 years. 44.4% of deaths occurred between the ages of 20 and 29 years. 55.6% deaths occurred in the postpartum period. 74.1% died on the ICU or obstetrics wards. 33.3% of cases were referrals from community hospitals, of which 7 were dead on arrival (4 from postpartum hemorrhage, 1 from eclampsia, and 1 severe eclampsia with intracerebral hemorrhage and puerperal sepsis.) A higher proportion of referrals was found in deaths for the most recent four year period. 92.6% (25 cases) were direct maternal deaths. 70.4% were from abortion complications, puerperal infection, and postpartum hemorrhage. The causes of death changed very little over the 10 year period, with the exception of pregnancy induced hypertension which did not appear in the most recent four year period. The findings indicate an improvement in the quantity and quality of obstetric and medical care and some changes in record keeping. Conferences are held with doctors in nearby hospitals to discuss referral procedures and management problems. Most of the maternal mortality is preventable.
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PMID:A 10-year review of maternal mortality in Chon Buri Hospital, Thailand. 808 22

Sixteen mothers died out of 2279 teenage deliveries contributing a high maternal mortality rate of 7.02 per 1000 during the study period. 15 adolescent mothers who died had no access to prenatal care. An increased incidence of low birth weight (less than 2.5 kg) babies was observed among teenage deliveries. Incidence of premature deliveries were more among teenage mothers. Severe anemia, puerperal sepsis and hypertension were the dominant complications experienced among adolescent mothers.
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PMID:Teenage pregnancy and its effect on maternal and child health--a hospital experience. 851 42

The empress and queen Maria Theresa Habsburg-Lorraine (May 13th, 1917-November 29th, 1780) bore sixteen children in the marriage with the emperor Franz I Stepha and was famous as "mother-in-law of Europe". Her brother Leopold died immediately after he was born, her sister Amalia died in the cradle and Maria Ana died of perinatal complications at the birth of a dead infant in 1744. The famous hereditary facial dysmorphia of the "Hasburg jawe" wasn't noticed in Maria Theresa's surviving children. In October of 1738, after giving birth to her daughter Ana, a manual lysis of the placenta was performed due to the retained placenta and postpartal bleeding. In 1741 her daughter Carolina died, and in 1767 her daughter Josepha died of small pox. Her daughter Elizabeth remained deformed by the pock marks, and Maria Christina got a puerperal sepsis, but surprisingly, didn't die. Maria Antoinette ended under a guillotine in France, along with her husband Luis XVI. Maria Theresa's father, Karl VI died of the cholecystopankreatitis and peritonitis, and her husband and co-ruler most probably died of acute coronary incident in August 18th, 1765. After her husband's death she started suffering from depression with steady necrophile obsessions. Maria Theresa suffered from a chronical obstructional pulmonary disease (asthma), rehumatic syndromes, hypertension and anxiodepressive syndromes. In 1767 she had small pox. In November 11th 1780 she caught a cold which grew into a pneumonia with high fever. She died of cardiopulmonal dedompensation preceded by pneumonia and asthma.
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PMID:[Pathography and biography of the Empress Maria Theresa]. 1176 37

Prenatal care aims to preserve the health of the fetus and mother. It screens for indications of illness or pregnancy-related complications and tries to prevent them from becoming emergencies. Sufficient referral services are needed for prenatal screening to be effective. Women and their families must be motivated to go to them promptly. Often prenatal care is the first time women receive any medical care. Thus, quality care is imperative so women will again request medical care when necessary. Prenatal care providers must ask women about signs and symptoms of placenta previa and placental abruptio. They should also tell them about the gravity of hemorrhaging in late pregnancy. Referral facilities must have operative capabilities and be able to provide adequate transfusion to treat severe hemorrhage. Health workers must prevent and treat anemia in pregnant women to improve their chances of recovery from blood loss; they must also measure blood pressure and periodically test for proteinuria and edema to diagnose preeclampsia, eclampsia, and hypertension. Health workers must screen women at high risk for cephalopelvic disproportion (e.g. by assessing, height, foot size, and age) and for a malpositioned fetus and multiple pregnancies (e.g. via abdominal examination). They must also educate mothers about the importance of hygienic delivery and provide sanitary delivery kits. Unhygienic delivery conditions and untreated sexually transmitted diseases (STDs) can cause puerperal sepsis. STDs can also have other adverse effects such as ectopic pregnancy and blindness, death, or retardation of the fetus/ infant. STD screening could prevent needless suffering in many women; 5-15% of pregnant women in some developing countries have syphilis. Prenatal care should include screening for urinary tract infections which can cause preterm delivery and low birth weight. Antibiotics can treat these infections. Some pregnant women have infectious diseases which may undetected without prenatal care.
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PMID:How prenatal care can improve maternal health. 1228 37

All pregnant women are at risk of developing life-threatening complications during pregnancy or childbirth. The majority of maternal deaths, however, are the result of complications such as hemorrhage, puerperal sepsis, hypertension, obstructed labor, and abortion which can be readily treated at an hospital or health center equipped to provide essential obstetric functions such as cesarean section, blood replacement, and medical treatment. Such maternal mortality can be successfully prevented without sophisticated technology. Even health centers with neither operative facilities nor all of the essential obstetric functions can provide first aid and stabilize patients by starting antibiotic treatment and rehydration before referral to an higher level of care. In so doing, women reach the referral hospital in better condition and improve their chances of survival. Linking health centers and referral hospitals is the key to maternal survival. The Safe Motherhood program is developing guides aimed at midwives, nurses, and non-specialist doctors at the first contact level and the first referral level designed to help health care providers cope with obstetric emergencies and prevent complications from becoming emergencies. Topics include planning of obstetric emergencies; the prevention and treatment of postpartum hemorrhage, severe anemia, prolonged labor, and ruptured uterus; use of the partograph to prevent prolonged or obstructed labor; the treatment of incomplete or inevitable abortion; the essentials of prenatal care; the identification of pre-eclampsia; and how to take blood pressure and maintain a sphygmomanometer.
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PMID:What is needed to ensure the health and survival of mother and baby? 1234 81

Postpartum is a crucial period for a mother. During this period a mother is going through the physiological process of uterine involution and at the same time adapting to her new role in the family. Many postpartum complications occur during this period. Among the important obstetric morbidities are postpartum hemorrhage, pregnancy related hypertension, pulmonary embolism and puerperal sepsis. Common surgical complications are wound breakdown, breast abscess and urinary fecal incontinence. Medical conditions such as anemia, headache, backache, constipation and sexual problems may also be present. Unrecognized postpartum disorders can lead to physical discomfort, psychological distress and a poor quality of life for the mothers. Providing quality postnatal care including earlier identification of the problems (correction) and proper intervention will help the mother to achieve full recovery and restore her functional status back to the pre-pregnancy state sooner.
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PMID:"Postpartum morbidity--what we can do". 1762 74

The spectrum of kidney disease occurring during pregnancy includes preeclampsia, hypertensive disorders of pregnancy, urinary tract infection, acute kidney injury, and renal cortical necrosis (RCN). Preeclampsia affects approximately 3-5% of pregnancies. We observed preeclampsia in 5.8% of pregnancies, and 2.38% of our preeclamptic women developed eclampsia. Severe preeclampsia and the eclampsia or hemolysis, elevated liver enzymes levels, and low platelets count (HELLP) syndrome accounted for about 40% of cases of acute kidney injury (AKI) in pregnancy. Preeclampsia/eclampsia was the cause of acute renal failure (ARF) in 38.3% of the cases. Preeclampsia was the most common (91.7%) cause of hypertension during pregnancy, and chronic hypertension was present in 8.3% of patients. We observed urinary tract infection (UTI) in 9% of pregnancies. Sepsis resulting from pyelonephritis can progress to endotoxic shock, disseminated intravascular coagulation, and AKI. The incidence of premature delivery and low birth weight is higher in women with UTI. The incidence of AKI in pregnancy with respect to total ARF cases has decreased over the last 30 years from 25% in 1980s to 5% in 2000s. Septic abortion-related ARF decreased from 9% to 3%. Prevention of unwanted pregnancy and avoidance of septic abortion are key to eliminate abortion-associated ARF in early pregnancy. The two most common causes of ARF in third trimester and postpartum periods were puerperal sepsis and preeclampsia/HELLP syndrome. Pregnancy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome and acute fatty liver of pregnancy were rare causes of ARF. Despite decreasing incidence, AKI remains a serious complication during pregnancy.
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PMID:The kidney in pregnancy: A journey of three decades. 2308 48


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