[Evolution of maternal mortality in a level 3 Tunisian maternity from 1998 to 2007]

The action plan for the maternal mortality is generally based on research studies' results carried out within hospital structure.

Determination and follow-up of the evolution of maternal mortality from 1998 to 2007 in a level 3 Tunisian maternity and identification of its main causes.

It is a retrospective study carried out between January 1998 and December 2007. In our service, since 1984, maternal deaths are systematically recorded. Information about deaths are collected from the following sources: childbirth folder, folder of hospitalization in reanimation, after the autopsy, through information collected beside the family, or by the National System of Maternal Death Surveillance, only since 1999.

Thirty-one mother deaths were colligated during the study. The average age of patients was around 33 years. The global maternal mortality rate during the study was about 56 deaths for 100,000 live births. The trend was characterized by a net decrease to this rate to 2003, and stagnation after that or even an increase in 2007. Deaths were due, in 81% of cases, to a direct obstetric reason. Hemorrhage was the principal etiology, which was implicated in 35.48% of the total cases. Complications of preeclampsia were incriminated in 19.35% of the total number of cases. In this set, transfer rate was about 48.38%.

The evolution over the years shows a net regression of maternal mortality. However, the trend was characterized by a recent stagnation. However most of cases were avoidable. Much progress has to be carried out in the cases of peripartum hemorrhages and preeclampsia, since they represent the main death causes.