Pregnancy - TTC - Parenting After 50: Re: Gotcha!

Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

According to the WHO, "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." ^[1]

Generally there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or their management, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem. Other fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.

Maternal mortality is a sentinel event to assess the quality of a health care system. However, a number of issues need to be recognized. First of all, the WHO definition is one of many; other definitions may also include accidental and incidental causes. Cases with "incidental causes" include deaths secondary to violence against women that may be related to the pregnancy and be affected by the socioeconomic and cultural environment. Also, it has been reported that about 10% of maternal deaths may occur late, that is after 42 days after a termination or delivery^[2], thus, some definitions extend the time period of observation to one year after the end of the gestation. Further, it is well recognized that maternal mortality numbers are often significantly underreported ^[3]. This may be due to lack of reporting of terminations and lack of social recognition of the pregnancy.

Dr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients.

"Lifetime risk of maternal death" accounts for number of pregnancies and risk. The estimated risk of an individual woman dying from pregnancy or childbirth during her lifetime, based on maternal mortality and the fertility rate in the country.

For a woman who had two deliveries in those Vienna Hospital during the 1846-1849 period, she had about an 80% chance of dying. In reality, without any form of birth control, many women had far greater numbers of pregnancies. Historically, it was not uncommon for many men to marry two or three different women in their lifetimes, after deaths of their earlier wives, usually in or around childbirth.

http://www.cahr.info/index_files/page0023.htm href="http://www.cahr.info/index_files/page0023.htm">Maternal Mortality in Central Asia, Central Asia Health Review (CAHR), 2 June, 2008
Koonin, Lisa M.; Hani K. Atrash, Roger W. Rochat, Jack C. Smith (12/1/1988). "Maternal Mortality Surveillance, United States, 19801985". MMWR 37 (SS-5): 1929. http://www.cdc.gov/mmwR/preview/mmwrhtml/00001754.htm.
Deneux-Tharaux, D; Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. (2005). "Underreporting of Pregnancy-Related Mortality in the United States and Europe". Obstet Gynecol 106: 684692.
Semmelweis (1861) p152

"I guess the poking and proding and blood-taking, and probing and week by week monitoring and blood pressure taking and temperature taking and all that, plus appointments (waiting and waiting in the lobby with folks that might actually BE sick) - la la la la la - great aversions. "

My experience was far different from what you describe, and my pregnancy was considered high-risk. I had blood taken only a few times. My appointments were no where near weekly. My blood pressure, a small urine sample and my fundal height (using a measuring tape to measure how high the uterus was) were done at each appointment, but I didn't have internal examinations but once before being in the hospital. As for waiting and waiting in the lobby, I don't remember waiting more than 15 or 20 minutes at any appointments, and certainly don't remember others there coughing and sniffling.

Annie