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This study assessed the extent, causes, and factors associated with maternal mortality (MM) during 1991-93 in Surinam. Data were obtained from a national mortality survey and verified with the doctors who signed death certificates. A single underlying cause was assigned to each death. Findings indicate that the national MM ratio was 226/100,000 live births (64 maternal deaths), which was 6 times higher than the official figures for the same period. 76.6% were due to direct maternal causes; 23.4% to indirect maternal causes. The main causes of death were hemorrhage (29.7%), pre-eclampsia (20.3%), complications from cesarean section (7.8%), sepsis from genital tract infections (6.3%), and other (7.8%). 87.5% died in the densely populated coastal area, 12.5% died inland, 82.8% died in a hospital, 3.1% died in health centers, and 14.1% at home. 71.7% had vaginal deliveries; 28.3% were delivered by cesarean section. Among 59 maternal deaths, 22% had no prenatal care, 45.8% had their first prenatal visit in the second half of the pregnancy, and 32.2% began prenatal care before the 20th week of gestation. 61.9% had uneventful obstetric histories. 12.7% had health risk factors. 95.2% of cases involved substandard care practices by the woman and her family, obstetricians, hospital care, and/or the organization of health care. Deaths from hemorrhage were mostly due to late blood transfusion. Deaths from eclampsia were due to late transport to the hospital.
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PMID:Nationwide maternal mortality in Surinam. 1042 60

In this study, 72 newborn infants who were followed with the diagnosis of poisoning in Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, between 1975 and 1997 were evaluated retrospectively. Our purpose was to emphasize the importance of newborn poisoning among general poisoning in childhood. The age of infants ranged from 10 min to 25 days (0.82 +/- 2.81 days). Forty-seven (65.2%) infants were poisoned before or during delivery. Of the 47 infants' mothers, 46 had preeclampsia or eclampsia, and 27 received only magnesium sulfate; nine magnesium sulfate + diazepam; four magnesium sulfate + nifedipine; and the others received various drug combinations. Aside from these, one mother had Addison's disease and she used long-term dexamethasone during her pregnancy. In the newborn period, five (6.9%) infants inhaled organophosphate insecticides; eight (11.1%) ingested corrosive agents (four benzalkonium chloride; three chlorhexidine gluconate + cetrimide and an infant ammonium); four (5.5%) were poisoned by overdose of digoxin; three (4.1%) ingested overdose of phenobarbital; and two (2.7%) received acepromazine maleate. In addition, each infant ingested diphenoxilate HCL + atropine sulfate, pipenzolate bromid and tizanidine HCL. Follow-up period of the infants ranged from 24 hr to 26 days (0.82 +/- 2.81 days). The mortality rate was 17% (12/72). Death was not noted in the infants who were followed with poisoning after delivery. The causes of death were as follows: sepsis in four infants, meningitis, respiratory distress syndrome and necrotizing enterocolitis in two infants each, and the effects of overdose of magnesium sulfate and diazepam in two infants, respectively. In conclusion, we would like to stress that newborn infants whose mothers received magnesium sulfate or another drug during pregnancy or delivery should be closely monitored, and calculation of drug doses should be carefully taught to hospital nurses. When baby-rooms are disinfected with organophosphate insecticides in a hospital or house, infants should be removed from the room for at least 24 hr, and use of drugs should be explained in detail to the mothers.
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PMID:Neonatal poisonings in middle Anatolia of Turkey: an analysis of 72 cases. 1084 89

Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care.
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PMID:Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. 1085 53

Right ventricular failure can be the result of acute respiratory distress syndrome (ARDS). A patient with eclampsia and sepsis with Staphylococcus aureus developed life-threatening right ventricular failure as a result of ARDS. She finally stabilized after treatment with inhaled nitric oxide (NO). The pathophysiology of right ventricular failure in ARDS is described.
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PMID:Right ventricular failure in acute respiratory distress syndrome. 1097 54

A study of cases of eclampsia treated at the University College Hospital (UCH), Ibadan, over a 10 year period (1987-1996) was carried out to evaluate the clinical presentation and management outcome during the period of study. There were 140 cases of patients with eclampsia who received treatment out of a total number of 10,584 deliveries during the same period. The incidence of eclampsia was higher among the primigravidae, young women who are less than 25 of age, and unbooked patients. About 85% of the patient were pre-delivery eclampsia, out of which about 60% had emergency caesarean sections. Fifteen percent (15%) of them had repeated convulsion while on anticonvulsant, and more than half of the eclamptics had control of blood pressure within 48 hours of delivery. Eclampsia accounted for 9% of total maternal deaths and perinatal deaths associated with eclampsia was 10%. The common causes of maternal death were acute renal failure, sepsis, and Disseminated Intravascular Coagulopathy (DIC). Eclampsia remains an important cause of maternal morbidity and mortality in this environment.
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PMID:Evaluation of cases of eclampsia in the University College Hospital, Ibadan over a 10 year period. 1112 82

Since 1996, maternal mortality is registered as part of a permanent confidential inquiry in France. The National Committee has studied all cases recorded to assess the cause of death and the avoidable obstetrical complications involved. Recommendations are proposed. In 1996 and 1997, there were 196 maternal deaths in France; 165 could be analyzed. The cause was obstetrical in 123 cases (74%), non-obstetrical in 26 (16%), and unidentified in 16 (10%). Ninety-seven direct deaths occurred (78% of the obstetrical mortality cases); 31 cases of hemorrhage including 19 post partum, 20 cases of pregnancy-induced hypertension, 10 cases of eclampsia and 7 of pre-eclampsia, 16 cases of amniotic fluid embolism, 11 cases of thromboembolism and 10 cases of sepsis. The National Committee considered that 54% of these deaths were avoidable: 87% for hemorrhage, 80% for sepsis, and 65% for hypertensive diseases. The deaths due to amniotic fluid embolism were not considered avoidable. This mortality stemmed from substandard care, delayed treatment, missed diagnosis, and professional errors. Clinical recommendations are proposed for post partum hemorrhage, pre-eclampsia and eclampsia, prevention of maternal infection, and thromboembolism prophylaxy.
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PMID:[Maternal mortality: avoidable obstetrical complications]. 1188 12

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

99% of all maternal deaths occur in the developing world, and South Asian countries account for most deaths. The causes are obstructed labor, hemorrhage, pregnancy-related hypertension (eclampsia), or unsafe abortion. The United Nation's Children's Fund estimates 340 maternal deaths for every 100,000 live births in India. In Indian rural areas, the maternal mortality rate is between 800 and 900 deaths per 100,000 live births in Bangladesh, 600; in Nepal, 830; and in Bhutan, 1710. IN comparison, the rate in the United States is 8 deaths per 100,000 live births. The technology for reducing maternal mortality has been utilized in most developed countries, as well as in parts of South Asia, in particular in Sri Lanka. The goal of the Safe Motherhood Initiative was to reduce maternal mortality by 50% by the year 2000. The immediate causes of maternal mortality include pregnancy and delivery and the management of complications such as hemorrhage, toxic and bacterial infections (sepsis), eclampsia, and obstructed labor. The poor health, nutrition, and socioeconomic status of women are the underlying causes of maternal death. One study in India found that inadequate medical treatment contributes to 36% to 47% of maternal deaths in hospitals. In India, abortion services are legal and acceptable on social, religious, and political grounds, but services are inaccessible. In Bangladesh, the availability of menstrual regulation is estimated to save 100,000 to 160,000 women from unsafe abortions each year. However, the inaccessibility of this service accounts for 700,000 unsafe abortions and 7000 maternal deaths. Gender bias in the allocation of meager food supplies results in the poor health and nutritional status of women, rendering a woman's pelvis too small, which causes obstructed labor and even death. Socioeconomic status is linked to access the family planning and health services which affect mortality and reproductive health. In Sri Lanka and Kerala, government investment in health and education has resulted in relatively high literacy and education education levels and low infant and maternal mortality compared to the rest of the region.
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PMID:Reducing deaths from pregnancy and childbirth. Asia. 1215 74

Women aged 15-19 represent a high proportion of the female population of the Dominican Republic, and their rate of consensual unions of 24.6% leads to high rates of adolescent pregnancy. A retrospective study was made of the records of 600 adolescent pregnancies followed between 1975- 80 at a maternity hospital in Santo Domingo. The adolescents were classified into 3 age groups. Group 1 included 27 adolescents aged 12- 14, group 2 included 305 aged 15-17, and group 3 included 268 aged 18- 19. 3 adolescents in group 1, 64 in group 2, and 108 in group 3 had already had a child, while 10 in group 2 and 38 in group 3 had 2 previous children. 7 in group 3 had 3 or more children. 1 mother in group 1, 7 in group 2, and 12 in group 3 had a history of cesarean section. 331 of the 600 had no form of prenatal care. 202 had 1-4 prenatal visits and 67 had 5 or more. Among the 331 adolescents with no prenatal care, there were 92 cases of threatened premature delivery, 30 of slight and 31 of moderate to severe toxemia, and 7 of eclampsia. Among the 269 patients with prenatal care, there were 19 cases of slight and 2 of moderate toxemia during pregnancy. On admission to the hospital, there were 58 cases of threatened premature deliver, 23 of slight and 14 of moderate to severe toxemia, and 14 of premature rupture of membranes. Among the total group of 600 adolescents, 25% had threatened premature delivery, 8.8% had slight and 7.5% had moderate to severe toxemia, 1.1% had eclampsia, 4.2% had premature rupture of membranes, 1.3% had abortions, and .5% had syphilis. 428 deliveries occurred at 38-40 weeks. There were 57 caesareans and 8 abortions. 214 newborns had Apgar scores of under 7 points. There were 15 fetal deaths in utero, 28 hemorrhages during delivery, and 3 cases of retention of the placenta. There were 3 maternal deaths due to sepsis. It is apparent that adolescent pregnancy entails a high degree of risk.
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PMID:[Adolescent fertility. 1. Pregnancy and childbirth]. 1217 96

Increasing interest is being shown in maternal mortality as a public health problem in developing countries, especially under the prompting of the Family Health Division of the World Health Organization. This paper assesses the data on maternal mortality in sub-Saharan Africa and provides estimates for different countries. It also discusses causes and possible interventions. The observed relationship between the risks of maternal death, the fertility rate, and the general mortality level among women of reproductive age can be used to estimate maternal mortality in countries lacking reliable data. Between 15-30% of all deaths in fertile-aged women are believed to be associated with pregnancy, labor, or the puerperium in most countries of Africa. The most important causes of maternal death are hemorrhage, sepsis, eclampsia, obstructed labor and uterine rupture, and aggravation of preexisting conditions. Quality and accessibility of medical care are the main determinants of the impact of treatment on maternal survival. Fertility-related factors are the most important influence on the frequency of complications. Maternal mortality can be reduced by reducing fertility, avoiding pregnancies at the extreme reproductive ages and higher parities, or reducing the number of unwanted births. General improvements in the health and nutritional status of women, adequate training of traditional birth attendants and medical staffs, and prenatal care can help reduce the occurrence of complications and provide better management if they occur. Most studies of maternal mortality are hospital-based and thus affected by selectivity. Vital registration systems are incomplete and unlikely to play a role in assessing maternal mortality in Africa for some time. Population-based surveys of different kinds are increasingly being used to assess the magnitude of maternal mortality, but such studies remain rare in Africa. Estimates of maternal mortality in sub-Saharan Africa based on its relationship to general mortality varied from 217/100,000 live births in Kenya to 827 in Chad. Some 80,000 women were estimated to have died each year between 1980-85. The maternal mortality ratio was estimated at 460. Maternal mortality data from studies conducted in Africa give widely varying results on levels, medical causes, and differentials. They are difficult to interpret and compare because of selection biases of different kinds. Only 34% of births occur in health facilities in Africa as a whole. Studies evaluating the effects of different interventions on maternal mortality are also lacking in Africa. It has been suggested that the best strategy for reducing maternal mortality in sub-Saharan Africa would involve providing better health services, training traditional birth attendants to improve their skills and eliminate harmful practices, and providing family planning programs.
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PMID:Maternal mortality in sub-Saharan Africa: levels, causes and interventions. 1217 25


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