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 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The maternal deaths occurring in the Kilimanjaro Christian Medical Center (KCMC), which serves as a supraregional reference hospital for the 5 regions of Northern and Central Tanzania, are reviewed for the 1971-1977 period and avoidable factors are discussed. All deaths occurring within the hospital during pregnancy or the first 6 weeks of the puerperium were included in this survey. Postmortem examination was performed in 35% of the cases. In the remaining cases the diagnosis was made on clinical grounds. During the period under review, there were 10 deaths among 83 cases, a mortality of 12%. The major cause of rupture was obstructed labor associated with a contracted pelvis or abnormal lie. 25% of the patients had had a previous cesarean section scar give way. 2 other deaths were attributed to anesthetic accidents and 1 was probably due to pulmonary embolism. The primary cause of death in the 7 remaining cases was hemorrhage (4) and sepsis (3). If deaths from ruptured uterus are to be avoided, early diagnosis is essential. 1044 cases of moderate and severe EPH gestosis (preeclampsia) were treated in KCMC during the period under review together with 54 cases of eclampsia. There were 5 deaths among the patients with eclampsia, a mortality of 9%. In addition to the 11 sepsis deaths there were 3 others included among the cases of ruptured uterus. There were 4 cases of septic abortion and 3 of those admitted to criminal interference. Preexisting anemia was a complicating factor in 5 cases, all of whom died within 15 minutes of arrival. There were 4 deaths among 251 cases of ruptured ectopic pregnancy. There were 10 deaths associated with cesarean section among 1271 sections peformed during the period under review. Deaths from associated diseases included the following: enterocolitis (12 deaths); renal and hypertensive disease (4 deaths); cardiac disease (2 deaths); anemia (2 deaths); malaria (2 deaths); tuberculous meningitis (2 deaths); and miscellaneous associated conditions (11 deaths).
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PMID:Maternal deaths in the Kilimanjaro region of Tanzania. 47 24

Ninety-one consecutive cases of coma were identified among gravidas at Maputo Central Hospital. The commonest causes were eclampsia (70 cases), cerebral malaria (six cases), and meningitis (five cases). Fetal mortality in eclampsia was 23 per cent and maternal mortality 10 per cent. There was a markedly higher incidence of eclampsia during the colder months.
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PMID:Coma in Mozambican gravidas: causes and perinatal outcome. 150

In the Central Hospital of Maputo we registered 1986 6 maternal deaths during delivery caused by cerebral malaria. Clinical and histopathological findings have been discussed. In endemic districts of malaria convulsions during delivery are hints to cerebral malaria. Following postpartal infections cerebral malaria together with eclampsia has the second position in the reasons of maternal death.
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PMID:[Cerebral malaria and maternal deaths--a study of 13,141 deliveries at the Maputo Central Hospital, People's Republic of Mozambique]. 329 92

Free fatty acids (FFA) in blood are carried by serum albumin. A hypothesis is offered that conditions giving a high molar ratio of FFA to albumin may lead to dysfunction of the cells which are directly exposed to the high FFA/albumin ratio, i.e. the red and white blood cells, and endothelial cells. The hypothesis is supported by observations of (1) hemolytic effect of FFA, and protection by albumin in vitro, (2) inhibition of white blood cells by FFA, (3) increased FFA/albumin ratio and erythrocyte susceptibility to hemolysis in pre-eclampsia, (4) increased incidence of eclampsia in undernutrition, (5) the paradox at famine suppresses and refeeding activates malaria, and (6) an inverse relationship between serum albumin level and mortality.
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PMID:Serum fatty acid/albumin molar ratio and the risk of diseases. 747 3

This article reports on an examination of maternal mortality in Guinea-Bissau during 1989-90. Verbal autopsies were conducted and matched to hospital and health center records. The 145 maternal deaths identified in this study were matched to controls. The estimated maternal mortality ratio (MMR) was 914/100,000 live births. The MMR for hospitals was 779/100,000. Few women with infections or hemorrhage received proper medical attention. Cases of obstructed labor usually involved malpresentation of the fetus and cephalopelvic disproportion. The main indirect causes of maternal mortality were anemia and malaria. Almost 70% of deaths were to women younger than 30. 32% of deaths to women younger than 20, 9% of deaths to women 20-29 years old, and 22% of deaths to women 30-39 years old were due to eclampsia. 27% of deaths among 30-39 year old women and 33% of deaths among women 40-49 years old were due to postpartum hemorrhage. The comparison of prepregnancy symptoms among women who died and women who did not showed that death was related to female genital mutilation, specifically excision or infibulation. This practice is common among certain tribes, which also have a young marriage age and slight stature. The highest mortality was among women with no prenatal care (45 deaths). 41 women who died made a few prenatal visits. 33 deaths were to women who made over 3 visits. 71% of the 145 women who died had experienced some complications (anemia, malaria, generalized edema with or without hypertension). Only 20.4% of women who died and 30.2% of living women were temporarily admitted to the hospital for these symptoms during pregnancy. 43% of survivors of a similar condition to those women who died made prenatal visits during the first trimester. Twice as many controls delivered at home compared to the hospital; the reverse held for women who died. 40% of women who died and only 26% of the control group had deliveries attended by family or traditional birth attendants. 14% versus 40% in the control had midwives delivering births. 28% versus 19% of control reached the health facility in over 24 hours. 53.7% versus 86.9% of controls had live births.
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PMID:Guinea-Bissau: maternal mortality assessment. 757 8

A community-based incidence case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (Odds Ratio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Maternal mortality in rural and urban Zimbabwe: social and reproductive factors in an incident case-referent study. 851 49

Antenatal complications in 340 booked and 710 unbooked adolescent mothers aged 12-14 years were evaluated over a 2-year period at the Specialist Hospital, Yola, Adamawa State, Nigeria. Emesis gravidarum was observed in 290 (85.3%) and 612 (86.2%) booked and unbooked mothers, respectively. While 112 (32.9%) booked mothers had malaria, this ailment was observed in 508 (71.5%) of unbooked mothers. Forty-six (13.5%) booked mothers suffered from anaemia as against 483 (68.0%) unbooked patients. It was observed that preeclampsia manifested in 62 (18.2%) booked and 158 (22.2%) unbooked mothers, while eclampsia occurred in 18 (5.3%) and 66 (9.3%) booked and unbooked mothers, respectively. The rates of premature deliveries were 16.20% in booked mothers and 22.82% in the unbooked group. Other notable complications observed in both groups include premature rupture of fetal membranes (PROM), preterm contractions, antepartum haemorrhage, and urinary tract infections. There were slightly higher frequencies of the above complications in 12-year-olds, and these decreased slightly towards the age of 14 years. Nine of the 10 above observed complications occurred more in the lower socioeconomic classes [3-4] than in the upper social economic classes [1-2] in significant proportions.
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PMID:Antenatal complications in adolescent mothers aged below 14 years. 1045 65

An estimated 15 million children under 5 die each year, most of them in developing countries. Some 1/2 million women die of causes related to pregnancy, leaving at least 1 million children orphaned. The World Fertility Surveys of the 1970s demonstrated the direct relationship between family planning and maternal-child health. Between 1985-2000, some 2 billion children are expected to be born, 87% of them in developing countries. Some 240 million will die before 5 years. The main causes of death in small children are acute diarrheal disease, respiratory infections, transmissible diseases preventable with vaccination, malaria, malnutrition, and high fertility. 3 aspects of reproduction have significant effects on child survival: spacing, parity, and maternal age. In 1986, approximately 2 million children under 5 died because of risks associated with rapid procreation, and it is estimated that 1/5 of all child deaths could have been prevented with longer birth intervals. Maternal exhaustion and the inability to give adequate care to several small children at once are believed to be the main causes. The problem of abortion or fetal death increases significantly beginning at the 3rd birth, and the proportion of low birth weight babies increases at the 4th birth. The risk of malnutrition increases in large families with limited resources. The safest ages for childbearing are 20-34 years; the worldwide infant mortality rate for mothers under 20 is about 126/1000. Adolescent mothers are at increased risk of problems in the pregnancy and delivery. Family planning can reduce risks related to spacing, family size, and maternal age, and also risk of congenital defects that increase for older mothers. According to the World Health Organization, each year there are some 500,000 maternal deaths, only 6000 of which occur in developed countries. Immediate causes of maternal death in developing countries include hemorrhage, sepsis, eclampsia, dystocic delivery, and induced abortion, but the underlying causes are related to the poor situation of the woman: poverty, illiteracy, lack of adequate prenatal health care, and childbearing at extreme ages. Estimates based on the World Fertility Survey suggest that if all women stating they wanted no more children used contraception, 30% of maternal deaths would be avoided. It is estimated that some 15 million women undergo induced abortions each year, with 100,000-200,000 resulting deaths.
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PMID:[Impact of family planning on maternal-child health]. 1215 88

Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality rates include political, geographic, and economic mechanisms of exclusion which affect the vast majority of the population in developing countries. Political power is concentrated in the hands of relatively small groups whose decisions about such expenditures as health care are usually more favorable to the privileged. A consequence of the very unequal regional development in most Third World countries is that health, educational, and most other resources are concentrated in large cities and perhaps 1 or 2 strategic regions, leaving most of the population underserved. The low social position of women leaves them doubly vulnerable. The social factors adding to risks of maternal mortality should be considered in programs of prevention if the causes and not just the consequences are to be addressed.
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PMID:[Maternal death: unequal risks]. 1228 79

Maternity care should prevent mortality and improve women's health different interventions are required for prevention and improvement. Healthy pregnancies require well-nourished women, free of infectious diseases, and under treatment for chronic treatable diseases. obstetric emergencies, however, can occur among healthy women also. Management of obstetric emergencies means access for women in need; services should include the ability to cross-match and transfuse blood for hemorrhage, to perform caesareans for obstructed labor, to administer antibiotics for infection, and to treat eclampsia. Prevention of unwanted and unplanned pregnancies reduces obstetric complications. Prenatal care is supposed to improve the health of pregnant women and to prepare women and their care providers for emergencies. Improvement in health is related to monitoring nutrition, hemoglobin levels, micronutrients such as iodine, and weight gain. Malaria and other endemic diseases need to be screened and treated. Risk assessment as a screening tool may mislead and create a false sense of security. Sexually transmitted diseases must be screened and treated. Studies need to be conducted to ascertain cost-effectiveness of screening. Preparation for unexpected problems in delivery must include a plan for transport, clearance of permission from a husband, or care in a maternity waiting home. Postpartum care can be improved with careful compliance with aseptic procedures and monitoring of labor. Delivery facilities should include an operating room, anesthesia, blood, other IV fluids, and drugs. Speed and competence must be assured. Accessible care means defining problem areas and addressing short, medium, and long-term problems, and assessing causes within the social structure, community, health system, or hospital. Goals of interventions must be clearly defined, and the probable impact determined. Evaluations of interventions that have multiplied since the Safe Motherhood Initiative began can lead to sustainable, effective services.
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PMID:Maternal care goals: life and good health. 1228 3


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