Statistics - Maternal Mortality

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Introduction

The maternal mortality ratio (MMR), the number of direct and indirect maternal deaths during a given period per 100,000 live births during the same period, varies greatly from country to country around the world. Historically maternal mortality was the major cause of death among the female population and only with improving health and education conditions have huge inroads been made into this statistic. Even so today, from the map below, it can be seen that there is a enormous difference between first world countries ant those developing countries.


WHO map maternal mortality ratio 2015

WHO map maternal mortality ratio 2015


Maternal deaths can be classified as resulting from either direct, Indirect or incidental mechanisms and can be further classified according to the International Classification of Diseases (ICD-10).


Statistics Links: Introduction | Reports | World Population | World Fertility | World Infant Mortality | Maternal Mortality | Australia | Brazil | Canada | China | Germany | India | Indonesia | Europe | Myanmar | Netherlands | Spain | United Kingdom | Romania | Uganda | United States | Australia’s mothers and babies - 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | Abnormal Development - Australian Statistics | BGD Tutorial - Applied Embryology and Teratology | | National Perinatal Statistics Unit | AIHW | Category:Statistics
Links: Ectopic Pregnancy

World Health Organization (WHO)

Classification of Maternal Deaths

  1. Direct deaths - result from obstetric complications of the pregnant state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the above e.g. eclampsia, amniotic fluid embolism, rupture of the uterus, postpartum haemorrhage.
  2. Indirect deaths - result from pre-existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by the physiological effects of pregnancy e.g. heart disease, diabetes, renal disease.
  3. Incidental deaths - result from conditions occurring during pregnancy, where the pregnancy is unlikely to have contributed significantly to the death, though there could still be a distant association, for example road accidents or some malignancies.


WHO Trends in Maternal Mortality 1990 to 2013
WHO - Trends in Maternal Mortality 1990 to 2013

Trends in Maternal Mortality 1990 to 2013

  • An estimated 289 000 women died in 2013 due to complications in pregnancy and childbirth, down from 523 000 in 1990.
  • more than 1 in 4 maternal deaths are caused by pre-existing medical conditions such as diabetes, HIV, malaria and obesity, whose health impacts can all be aggravated by pregnancy.
    • A related WHO study of causes of more than 60 000 maternal deaths in 115 countries caused 28% of the deaths.
  • similar to the proportion of deaths during pregnancy and childbirth from severe bleeding.
    • severe bleeding (mostly during and after childbirth) 27%
    • pregnancy-induced high blood pressure 14%
    • infections 11%
    • obstructed labour and other direct causes 9%
    • abortion complications 8%
    • blood clots (embolism) 3%.

Ten countries account for about 60% of global maternal deaths:

  1. India (50 000)
  2. Nigeria (40 000)
  3. Democratic Republic of the Congo (21 000)
  4. Ethiopia (13 000)
  5. Indonesia (8800)
  6. Pakistan (7900)
  7. United Republic of Tanzania (7900)
  8. Kenya (6300)
  9. China (5900)
  10. Uganda (5900)
Region Maternal mortality ratio (MMR) Range of MMR uncertainty Number of maternal deaths Lifetime risk of maternal death
(maternal deaths per 100 000 live births) Lower estimate Upper estimate 1 in:
World 210 160 290 289000 190
Developed Regions 16 12 23 2300 3700
Developing Regions 230 180 320 286 000 160

(Modified from Report Table 2. Estimates of maternal mortality ratio, p22)


Links: Reports | Report Page

Australia

2006-2010

Maternal deaths in Australia 2006-2010[1]

Over the five years 2006-2010, there were 99 maternal deaths in Australia according to the report, Maternal deaths in Australia 2006-2010. This equates to a rate of 6.8 deaths per 100,000 women who gave birth in Australia. While lower than the rates for the previous three year reporting period 2003-2005 (8.4 deaths per 100,000 women who gave birth), and 2000-2002 (11.1 deaths per 100,000 women who gave birth), trends should be interpreted with caution due to the small numbers and the rare occurrence of these deaths.

In 2006-2010 there were 39 direct maternal deaths and 57 indirect deaths. Three deaths were not able to be classified as direct or indirect.

  • leading causes of direct maternal death included embolism (a blockage of major blood vessels) caused by amniotic fluid (accounting for 9 deaths) or blood clot (8), and haemorrhage (7).
  • leading cause of indirect maternal death was cardiac disease (15 deaths), followed by deaths due to psychosocial morbidity (related to mental health and substance abuse issues) (13 deaths).
  • women who died were aged between 17 and 45 years, with women aged over 40 being at higher risk of maternal death.
  • A higher number of previous pregnancies was also associated with increased risk, as was residing in Remote or Very remote areas.
  • Indigenous women were about three times as likely to die as non-Indigenous women, with a maternal mortality rate of 16.4 deaths per 100,000 women giving birth (9 deaths).
  • Sepsis and cardiac conditions have been the leading causes of maternal death among Indigenous women over the period 1997 to 2010.


Links: Australian Statistics | Birth | Reports

2003-2005

Data shown below from the most recent triennial report "Maternal deaths in Australia 2003-2005".[2]


Australia’s low maternal mortality rate

Over the three years, 65 deaths were classified as directly or indirectly relating to the pregnancy or its management, with all deaths occurring while the women were pregnant, or within 42 days of termination of pregnancy. During the triennium, one woman died for every 11,896 women giving birth, giving a maternal death ratio of 8.4 per 100,000 of women giving birth. This compares favourably with the reported Maternal Mortality Rates (MMR) in other developed countries (WHO 2007).

Indigenous results are the great exception=

Maternal mortality rates for Aboriginal or Torres Strait Islander women were more than two and a half times as high as for other women. There were 21.5 deaths per 100,000 women giving birth, versus 7.9 per 100,000 for non-Indigenous women. This high rate is consistent with previous reports. The lack of improvement indicates that further measures are needed to improve the pregnancy outcomes for Aboriginal and Torres Strait Islander women.

Leading causes of maternal deaths

The leading causes of direct maternal deaths (29) were:

  • amniotic fluid embolism
  • thromboembolism
  • hypertension

The leading causes of indirect maternal deaths (36) were:

  • cardiac disease
  • psychiatric related causes
  • non- obstetric haemorrhage


Links: Maternal deaths in Australia 2003-2005

United Kingdom

Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom

BJOG. 2011 Mar;118 Suppl 1:1-203. doi: 10.1111/j.1471-0528.2010.02847.x.

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Abstract In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.

PMID 21356004

Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006-8: a review

Br J Anaesth. 2011 Aug;107(2):127-132. McClure JH, Cooper GM, Clutton-Brock TH; on behalf of the Centre for Maternal and Child Enquiries. Source Simpson Centre for Reproductive Health, Department of Anaesthesia and Pain Medicine, Royal Infirmary, Edinburgh EH16 5SA, UK. Abstract This review of the eighth report of the United Kingdom Enquiries into Maternal Deaths, Saving Mothers' Lives, is written primarily for anaesthetists and critical care specialists involved in both maternity and gynaecology services. Direct maternal deaths from systemic sepsis secondary to infection of the genital tract have increased. Systemic sepsis requires early recognition, immediate treatment and multidisciplinary management involving anaesthetists and critical care specialists. The incidence of deaths related to anaesthesia remains unchanged at seven in the three year period. Airway related problems unfortunately still cause maternal death. The role of early communication between obstetricians and anaesthesia and intensive care specialists is highlighted. The review summarizes the recommendations relating to anaesthesia and intensive care.

PMID 21757549

References

  1. Johnson S, Bonello MR, Li Z, Hilder L & Sullivan EA. 2014. Maternal deaths in Australia 2006-2010. Maternal deaths series no. 4. Cat. no. PER 61. Canberra: AIHW. AIHW
  2. Sullivan EA, Hall B & King J F 2008. Maternal deaths in Australia 2003-2005. Maternal deaths series no. 3. Cat. no. PER 42. Canberra: AIHW. Viewed 25 June 2014 <http://www.aihw.gov.au/publication-detail/?id=6442468086>.


Terms

  • lifetime risk of maternal death - is the probability of both becoming pregnant and the probability of dying as a result of that pregnancy cumulated across a woman’s reproductive years.
  • maternal mortality rate - is the number of maternal deaths in a given period per 100,000 women of reproductive age during the same period, reflects the frequency with which women are exposed to risk of death through fertility.
  • maternal mortality ratio - is the number of maternal deaths during a given period per 100,000 live births during the same period. This is a measure of the risk of death once a woman has become pregnant.

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Cite this page: Hill, M.A. (2018, December 15) Embryology Statistics - Maternal Mortality. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Statistics_-_Maternal_Mortality

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© Dr Mark Hill 2018, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G