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P.A. 4
MATERNAL MORTALITY
Maternal mortality is a negative demographic phenomenon, with major social and
health-related implications. It is a true indicator of a population’s health-state, which
reflects both the socio-economic development of a country and the development of the
health-care system, as well as the health-related cultural and educational level of the
population. As it also reflects the involvement of states and governments in achieving
social welfare (by the percentage of GDP allocated to health), maternal mortality is, as
recommended by UN experts in populations, an indicator that may be used for the
synthetic characterization a country’s level of socio-economic development.
Definition: maternal mortality refers to the death of a woman during pregnancy or
within a period of 42 days after the end of it, whatever the duration or location of
pregnancy, by any cause determined or aggravated by pregnancy, which is neither
accidental nor coincidental.
Deaths may be divided into two groups:
1. Deaths associated with direct obstetric causes - those resulting from obstetric
complications (pregnancy, childbirth, confinement), interventions, omissions, incorrect
treatment, or a concatenation of events resulting from one of the above-mentioned
factors.
2. Deaths associated with indirect obstetric causes - those resulting from preexisting diseases or a disorder occurring during pregnancy, without its being due to direct
obstetric causes, but aggravated by the physiological effects of pregnancy.
Direct obstetric causes of death:
- abortion
- obstetrical risk from
 complications of pregnancy
 complications of labor and birth
 complications during confinement
Death by abortion and, respectively, by obstetrical risk, is studied separately,
given the fact that their determinants quite different.
International statistics and those obtained in our country take into account only
deaths from direct obstetric causes (mortality from complications of pregnancy, birth and
confinement).
Way of calculation:
The index is calculated in relation to the number of live births registered within a
certain period and a certain territory:
dsnl
Msnl =
x 1000
nv
For analysis-related purposes, the index is calculated in relation with the age groups of
the deceased:
dsnlx
Msnlx =
x 1000
nvx
Msnl = the index of mortality associated with complications of pregnancy, birth and
confinement
dsnl = number of persons having died of these complications
nv = live births
The elements marked with “X” also refer to the age group of the dead persons and
to the live infants of mothers having died at the respective age.
Causes of maternal mortality by obstetrical risk are: toxemia, hemorrhage,
puerperal infection.
The most frequent causes are:
- in developed countries: hemorrhage, toxemia; in some countries many deaths
caused by abortion are not reported as such, due to religious or moral reasons.
- in underdeveloped countries: infection, bleeding, injuries at birth
Causes of bleeding:
- uterine rupture
- disseminated intravascular coagulation
- incomplete placenta deliverance
- placenta praevia
- abortion
Puerperal infections can be puerperal, nosocomial, etc.
The evolution of maternal mortality through obstetrical risk and abortion
In Romania:
During the prewar period, maternal mortality used to be high, especially in
rural areas, due to women’s limited education for health and to a very high birth
rate. After that period, the evolution of maternal mortality has been associated
with a particular aspect, namely the poorly implemented demographic policy
(Decree 770/1966 and regulations concerning the interruption of the normal
pregnancy course, in 1985). Between 1967 and 1990, in parallel with an increase
in natality (associated with the above-mentioned decree), an increase in maternal
mortality was also recorded, so that, in 1989, there were 1.7 ‰ live births (0.22
‰ from obstetrical risk and 1.48 ‰ from abortion). After the liberalization of
abortions, maternal mortality decreased to 0.83 ‰ in 1990, to 0.53 ‰ in 1992,
and to 0.48 ‰ in 1995.
In Europe
In 1995 the average level of maternal mortality was of 60/0000 in Western
Europe, of 180/0000 in Central and Eastern Europe and of 410/0000 in NEI
(independent countries).
In the 90s, the level of maternal mortality stabilized in Western European
countries and NEI. In Central and Eastern European countries, it continued to
decline slightly after the collapse of the 1990 indicator, mainly due to the
particular evolution in Romania.
Although Romania records decreasing values, these continue to be the
highest in Europe.
Induced abortion remains the main contraception means in Central and
Eastern European countries and the NEI, though being the main cause of
maternal mortality in these countries.