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Int J Gynaecol Obstet. 1981 Aug;19(4):259-66.

Maternal mortality at twelve teaching hospitals in Indonesia-an epidemiologic analysis.

Abstract

Records on 36,062 maternity cases admitted to 12 teaching hospitals throughout Indonesia between 1977 and 1980 were analyzed. A hospital maternal mortality rate of 37.4/10,000 cases (39.0/10,000 live births) was derived that was about ten times higher than rates reported from developed countries in the early seventies. Hemorrhage, infection and toxemia accounted for 91.2% of deaths resulting from direct obstetric causes and for 86,1% of total deaths. It is postulated that if all pregnant women received adequate antenatal care, and if all women wanting no additional children were sterilized, maternal mortality would be cut in half. It is recommended that maternal health services in Indonesia be integrated into its successful family planning program.

PIP:

In 1976, the Coordinating Board of the Indonesian Fertility Research Program (BKS PENFIN) conducted a study using data on 36,062 deliveries (among them, 135 maternal deaths) between 1977 and 1980 from 12 participating hospitals throughout Indonesia. Maternal deaths were defined as maternity cases who died upon arrival or after admission (including those who died before the fetus was delivered). Number of maternal deaths/10,000 maternity cases was calculated as the maternal mortality rate (MMR), which better represents the risk of dying. Relevant ante-, intra-, and post partum data were collected. Causes of maternal deaths were categorized according to the criteria used by the Committee on Maternal and Child Care of the American Medical Association. A comparison of MMRs among differing categories of maternity cases was used as the basis for studying risk factors. The findings in this hospital-based study do not apply to the general population because 80% of deliveries in the country take place at home and also because the mechanism of patient referrals to the hospitals is not well understood. MMR was 37.4. Per 10,000 live births, the rate would be 39.0. Of 108 cases of deaths available for analysis, hemorrhage, infection and toxemia accounted for 93 or 91.2% of deaths directly attributable to obstetric causes and for 86.1% of fetal deaths. 9 patients died of other causes (anesthesia-related complications, transfusion reaction, amniotic fluid embolism). All but 9 of 108 women were admitted as emergency cases and 40 were moribund. Simultaneous consideration of age and parity revealed a higher MMR in women younger than 20 with a parity of 2 or more, and a somewhat higher MMR in women older than 30 years who were delivering their first baby. Grand multiparas 35 years or older had the highest parity rate. MMR was 59.9 for women who made no antenatal visits compared to 11.4 for those who made 1 or more visits, a difference of 5.3 times. Antenatal visits was the highest relative risk detected among the risk factors, suggesting its significance in the causal chain leading to maternal mortality. The importance of sterilization of women desiring no additional children is discussed, as is the impact of family planning programs on maternal health.

PMID:
6119252
DOI:
10.1016/0020-7292(81)90072-2
[Indexed for MEDLINE]

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