The Problem of Indirect Causes of Maternal Mortality

Manuel Antonio Diaz de Leon Ponce; Briones Garduno Jesus Carlos; Moreno Santillan Arm; o Alberto

doi:10.4172/2376-127X.1000126

ISSN: 2376-127X

Journal of Pregnancy and Child Health

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The Problem of Indirect Causes of Maternal Mortality

*Manuel Antonio Diaz de Leon Ponce^1, Briones Garduno Jesus Carlos² and Moreno Santillan Armando Alberto³**
¹Member of the National Academy of Medicine (Mexico) and Mexican Academy of Surgery, Fellow of the American College of Physicians, Mexico
²Member of the National Academy of Medicine (Mexico) and the Mexican Academy of Surgery, CMD in Obstetrics and Gynecology Intensive Care Unit, General Hospital of Mexico “Dr. Eduardo Liceaga” SSA, Mexico
³Department of Obstetrics, Obstetrics and Gynecology Hospital “Dr. Luis Castelazo Ayala” IMSS, Mexico
Corresponding Author :	Manuel Antonio Diaz de Leon Ponce Naranjo 94 -303, Colonia Santa Maria la Ribera CP Delegacion Cuauhtemoc, Mexico City, Mexico Tel: 52 55 4169 43 E-mail: manueldeleonponce@hotmail.com
Received September 06, 2014; Accepted December 23, 2014; Published December 24, 2014
Citation: de Leon Ponce MAD, Jesus Carlos BG, Armando Alberto MS (2015) The Problem of Indirect Causes of Maternal Mortality. J Preg Child Health 2:126. doi: 10.4172/2376-127X.1000126
Copyright: © 2015 de Leon Ponce MAD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Introduction: Maternal mortality remains as a major Public Health challenge. About 800 women die from pregnancy related complications around the world every day. In 2013, 289 000 women died during and following pregnancy and childbirth. Almost all of these deaths (99%) occur in developing countries, and most could have been prevented. In Mexico there are still a significant number of deaths that are not properly registered as maternal deaths, so in the present study we analyze the causes and classification of maternal deaths occurred in six Intensive Care Units (ICUs) in Mexico in the period 1973 - 2013.

Material and methods: We realized a retrospective analysis of all maternal deaths during a forty year period (1973–2013) occurred in six Mexican Intensive Care Units (ICUs). We also review the diagnostic criteria, previous diseases; pregnancy related risk factors, state of hospitalization, length of stay, number of co-morbid conditions, adverse events and type of organic failure.

Results: We identified during the last 40 years 7735 maternal deaths (maternal mortality ratio of 7.2% per year). From the total deaths, 6723 were direct causes and 1012 were indirect causes. In the 75% of the total indirect causes the patients received prenatal control in the first level of attention, and were referred to the third level of attention only when the mortal complication was an essentially untreatable.

Keywords

Maternal mortality; Indirect causes

Introduction

Maternal mortality remains as a major Public Health challenge despite numerous strategies devised by the international community. About 800 women die from pregnancy related complications around the world every day. In 2013, 289 000 women died during and following pregnancy and childbirth. Almost all of these deaths (99%) occur in developing countries, and most could have been prevented [1-3].

Improving maternal health is 1 of the 8 Millennium Development Goals (MDGs) adopted by the international community in 2000. Under MDGs, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Since 1990, maternal deaths worldwide have dropped by 45%. However, between 1990 and 2013, the global maternal mortality ratio (i.e. the number of maternal deaths per 100 000 live births) declined by only 2.6% per year. This is far from the annual decline of 5.5% required to achieve MDGs [1-4].

The maternal mortality ratio in developing countries in 2013 is 230 per 100 000 live births versus 16 per 100 000 live births in developed countries. There are large disparities between countries, with few countries having extremely high maternal mortality ratios around 1000 per 100 000 live births. The high number of maternal deaths in some areas of the world reflects inequities in access to health services, wrong health policies and highlights the gap between rich and poor [1-5].

Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death [5-7].

Poor women in remote areas are the least likely to receive adequate health care. While levels of antenatal care have increased in many parts of the world during the past decade, only 46% of women in low-income countries benefit from skilled care during childbirth [5-7].

The problem of Mexico

In 2011, the Mexican Federal government reported that Mexico won’t be able to achieve the Millennium goal regarding maternal mortality decline. High maternal mortality rates are principally a failure of political will and attention, reflected in poor policy design, inadequate capacitation of the medical personal and inequities in access to health services [8,9].

In Mexico there are still a significant number of deaths that are not properly registered as maternal deaths, this is because maternal mortality is hard to measure among all the National Institutes of Health, although the WHO has clearly defined maternal mortality and there are specific definitions for the four types of maternal deaths (direct obstetric, indirect obstetric, late maternal, and related to the pregnancy). The objective of the present study is to analyze the causes and classification of maternal deaths occurred in six Intensive Care Units (ICUs) in Mexico in the period 1973 – 2013 [9-11].

Materials and Methods

We realized a retrospective analysis of all maternal deaths during a forty year period (1973–2013) occurred in six Mexican Intensive Care Units (ICUs). The data for this study was extracted from the review of the ICU’s medical records. Each maternal death was scrutinized to pin point the exact cause of death (according to the International Statistical Classification of Diseases and Related Health Problems) and the cause of maternal death was classified according to the WHO recommendations. We also review the diagnostic criteria, previous diseases; pregnancy related risk factors, state of hospitalization, length of stay, number of co-morbid conditions, adverse events and type of organic failure.

Results

We identified during the last 40 years 7735maternal deaths occurred in six different ICUs, which represents a maternal mortality ratio of 7.2% per year. From the total deaths, 6723 were direct causes and 1012 were indirect causes (Table 1). Maternal deaths were highest in the age group 15 -20 years (39%) followed by 25 - 30 years (31%) and 31- 35 years (25%).The direct causes of maternal mortality are presented in Table 2. The Table 3 shows how the indirect causes of maternal mortality were classified into ten groups.

The analysis of the indirect causes of maternal mortality reveal that in 760 cases (75%), the patients received prenatal control in the first level of attention, and they were referred to the third level of attention only when the mortal complication was an essentially untreatable.

Conclusion

While there are numerous factors that contribute to maternal mortality, we focus on the problem of the indirect causes of maternal mortality. In the most of the cases the maternal and obstetric complication and its outcomes could be prevented by an adequate health policy, which contemplates an opportune diagnosis of the non pregnancy related diseases and its opportune attention in the third level of attention health services.

We argument that many cases cataloged as indirect maternal death are really due to direct causes, including adverse incidents that occurred during pregnancy, such as:

a) Lack of medical acknowledgment about critical care obstetrics

b) Lack of real specialists coordination

c) Lack of good quality obstetrics critical care units

d) Lack of high risk pregnancy clinics y hospitals with full equipment and technology

These adverse incidents are classified in omission or commission events, committed by the doctor, the hospital or the institution and the severity can lead to maternal death. That is why we support the fact that these adverse effects must be count on direct maternal death cases. The Prevention of Maternal Mortality Program must a collaborative effort of the federal government, medical authority and the medical multidisciplinary team.

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