Anaesthesia and maternal mortality

Abstract

By international agreement obstetric deaths are divided into direct and indirect categories. Direct obstetric deaths are those resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect obstetric deaths are defined as those resulting from previous existing disease, or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiological effects of pregnancy. In addition, fortuitous deaths are a category recorded in the Reports on Confidential Enquiries into Maternal Deaths for the triennial periods between 1976 and 1984. They are deaths which occur fortuitously in pregnancy or the puerperium from unrelated causes and these are excluded from maternal mortality as it is internationally defined. Prior to 1976 the Confidential Enquiries had classified maternal deaths as true or associated deaths. True maternal deaths roughly equated with direct deaths, associated deaths were a sum of indirect and fortuitous types. For the purposes of this review the numbers of maternal deaths and the mortality rates will refer to direct obstetric deaths as far as possible.