Abstract
BackgroundData on maternal deaths occurring after the 42 days postpartum reference time is scarce; the objective of this analysis is to explore the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes in the Americas between 1999 and 2013, and to recommend including these deaths in the monitoring of the Sustainable Development Goals (SDGs).MethodsExploratory data analysis enabled analyzing the magnitude and trend of late maternal deaths and deaths from sequelae of obstetric causes for seven countries of the Americas: Argentina, Brazil, Canada, Colombia, Cuba, Mexico and the United States. A Poisson regression model was developed to compare trends of late maternal deaths and deaths from sequelae of obstetric causes between two periods of time: 1999 to 2005 and 2006 to 2013; and to estimate the relative increase of these deaths in the two periods of time.FindingsThe proportion of late maternal deaths and deaths from sequelae of obstetric causes ranged between 2.40% (CI 0.85% – 5.48%) and 18.68% (CI 17.06% – 20.47%) in the seven countries. The ratio of late maternal deaths and deaths from sequelae of obstetric causes per 100,000 live births has increased by two times in the region of the Americas in the period 2006-2013 compared to the period 1999-2005. The regional relative increase of late maternal death was 2.46 (p<0.0001) times higher in the second period compared to the first.InterpretationAscertainment of late maternal deaths and deaths from sequelae of obstetric causes has improved in the Americas since the early 2000’s due to improvements in the quality of information and the obstetric transition. Late and obstetric sequelae maternal deaths should be included in the monitoring of the SDGs as well as in the revision of the International Classification of Diseases’ 11th version (ICD-11).
Highlights
Reducing maternal mortality (MM) was a key objective in international development [1], a fundamental component of the Millennium Development Goals (MDGs), and remains a pressing unfinished agenda for the post-2015 Sustainable Development Goals (SDGs) [2]
This change arose from the fact that Member States of the Americas expressed their concern regarding the inclusion of late and sequelae maternal deaths in maternal mortality ratio (MMR) estimations through the Pan American Health Organization’s 54th Directing Council held in Washington D.C. in October 2015, documented in resolution CD54.R18. [12]; this has pushed the need for analyses on the trend and magnitude of late maternal deaths in the Americas
[13] This definition corresponds to the codes O00-O95 and O98-O99 of the International Classification of Diseases’ 10th revision (ICD-10 volume 2), and excludes deaths from any obstetric causes occurring after 42 days but less than one year after delivery, deaths from sequelae of obstetric causes occurring one year or more after delivery, as well as deaths related to obstetrical tetanus
Summary
Reducing maternal mortality (MM) was a key objective in international development [1], a fundamental component of the Millennium Development Goals (MDGs), and remains a pressing unfinished agenda for the post-2015 Sustainable Development Goals (SDGs) [2]. The MMEIG developed estimation methods addressing the constraints related to the use of reported data, and analyzing MM trends from 1990 onwards [14, 15]; the estimates for the 1990–2013 period included all deaths coded to chapter XV of the ICD-10, including late maternal deaths and deaths from sequelae of obstetric causes (coded O96-O97), in order to maintain comparison with previous data sets [11]. This criterion diverges from the definition of a maternal death as per the ICD-10 volume 2. Our objective is to examine the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes between 1999 and 2013
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