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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Published on: January 12, 2018

External causes and maternal mortality: proposal for classification.

Mércia Maria Rodrigues Alves1, Sandra Valongueiro Alves, Maria Bernadete de Cerqueira Antunes

  • 1Universidade Federal de Pernambuco, Departamento de Medicina Preventiva e Social, Programa de Pós-Graduação Integrado em Saúde Coletiva, RecifePEBrazil.

Revista De Saude Publica
|September 17, 2013
PubMed
Summary

External and undefined cause deaths in women of childbearing age during pregnancy and postpartum are significant. Excluding these deaths from maternal mortality ratios increases underreporting, highlighting the need for comprehensive data collection.

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Published on: December 5, 2015

Area of Science:

  • Public Health
  • Epidemiology
  • Maternal Health

Background:

  • Maternal mortality ratios (MMR) are critical indicators of healthcare quality.
  • Underreporting of deaths due to external and undefined causes can distort MMR.
  • Accurate classification of all maternal deaths is essential for effective public health interventions.

Purpose of the Study:

  • To analyze deaths from external and undefined causes in women of childbearing age during pregnancy and early postpartum.
  • To assess the impact of classifying these deaths on maternal mortality indicators.

Main Methods:

  • Study population: 399 women of childbearing age in Recife, Brazil (2004-2006).
  • Methodology: Reproductive Age Mortality Survey (RAMS) using standardized questionnaires.
  • Data sources: Institute of Legal Medicine, hospital records, Family Health Strategy records, and interviews.
  • Classification: ICD code O93 for external causes of death during pregnancy.

Main Results:

  • Eighteen pregnancy-associated deaths identified; most were young, Black, single mothers with 4-7 years of schooling.
  • Fifteen deaths classified as pregnancy-related (13 homicide, 2 suicide); 3 as indirect obstetric deaths (1 homicide, 2 suicide).
  • Classification resulted in an average 35% increment in the maternal mortality ratio (MMR).

Conclusions:

  • Deaths from external and undefined causes during pregnancy and postpartum are not random events.
  • Excluding these deaths from MMR calculations significantly increases underreporting.
  • Comprehensive data collection and classification are crucial for accurate maternal mortality assessment.