Maternal Mortality in the Czech Republic during1978 - 1997

Overview

Objective:
To analyze causes of maternal deaths during 1978 - 1997 in the Czech Republic.Design: Retrospective epidemiological study.Setting: Department of Obstetrics and Gynecology, I st Medical School, Charles University, Praha2, Institute for the Care of Mother and Child, Praha 4.Methods: The database of 521 maternal deaths which occurred during 1978 - 1997 was used toanalyze causes of deaths with regard to demographic characteristics, time development since theoccurrence of complications leading to death, age and parity, places of death including the type offacility, regional distribution, and actual historical situation of the Czech Republic during theobserved period. The effect of interventions and quality of care were also taken into account. Weprovide the trend analysis of specific (direct) and non-specific (undirect) maternal mortality in5-year periods.Results: Maternal mortality decreased from 29 deaths to 6 deaths per 100,000 live born newbornsduring the study period. Due to prevention of thrombembolic complications in 1993 by introduc-tion of obligatory micro-heparinization and prophylaxis of postoperative puerperal infections thematernal mortality decreased further by more than half. Hemorrhagic complications, usuallywith disorders of coagulation, become the leading cause of death; we are also observing increasedincidence of HELLP syndrome. While evaluating quality of care we list the major mistakes andomissions in prevention, diagnosis and therapy; we noticed that in 32% of maternal deaths thecare was not adequate according to possibilities and circumstances in a particular time period.Conclusions: Due to systemic surveillance of maternal deaths and introduction of preventivemeasures the Czech Republic belongs among the most developed countries in this area. We fur-ther intend to publish results of analysis of maternal mortality in particular nosologic groupsaccording to cause of death.

Key words:
maternal mortality, causes of deaths, prevention, quality of care