This study was carried out to determine the incidence and causes of
maternal deaths about a 20-year period at the Zekai Tahir Burak Women's
Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All
maternal deaths from January 1982 to July 2001 were reviewed and
classified retrospectively. Using a computer-generated list, 348
patients admitted to the Labour Department of ZTBWHERH during 1982-2001
were selected as controls. Medical records were reviewed for
demographic data, history of antenatal care, route of delivery,
referral history, and perinatal mortality. Cases and controls were
compared, and standard tests were used for calculating odds ratio (OR)
and 95% confidence interval (CI) for the association of demographic and
delivery characteristics. During this period, there were 174 maternal
deaths and 430,559 livebirths, giving a maternal mortality ratio of
40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000
in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were
due to direct obstetric causes and 24 (13.7%) were abortion- related,
while 20 (11.4%) were due to indirect obstetric causes. The most common
cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed
by obstetric haemorrhage and embolism. Abortion-related sepsis and
haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty
liver of pregnancy, and ectopic pregnancy accounted for other causes of
deaths. Cardiovascular disease was the leading indirect cause of death.
Referral, lack of antenatal care, and foetal death at admittance were
associated with 8-, 3-, and 6-fold increased risk of maternal mortality
respectively (OR 8.89, 95% CI 5.7- 13.8; OR 3.74, 95% CI 2.5-5.5; OR
6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have
declined at the hospital, especially in the past five years, the rate
is still high, and further improvements are needed. The problem of
maternal mortality remains multifactorial. Short-term objectives should
be focused on improving both medical and administrative practices.
Improving the status of women will necessarily remain a long-term
objective