Main Causes of Maternal Mortalityduring 1978 - 1997 in the Czech Republic

Overview

Objective:
To analyze changes in frequency of caesarean section in the Czech Republic duringperiod 1978 - 1997.Design: Descriptive epidemiologyMethods, Results, Discussion, Conclusion: The total cohort of all maternal deaths was analyzedregarding the main causes of death and the mode of delivery. Since 1978, a systematic analysis ofindividual cases of maternal deaths has been performed, in terms of their causes, course andavertabiliy (446 direct, specific and indirect, unspecific deaths). Thromboemboly, which was themain cause of maternal mortality until 1993, factually ceased to occur in the last four years.Currently, hemorrhage is rated as the 2nd cause, followed by cardiovascular - and further post-surgical complications, toxicosis, infections etc. In 34% of all cases in the period beginning from1978, we strictly stated inadequate medical procedures. These cases are analyzed at medical foraand, subsequently, disclosed and published, anonymously. The increase in the number of caesare-an sections from 3,5% to 11,9% in the course of years 1978 to 1997 presents a remarkable share ofmaternal mortality in the CR. While the share of intra- and postnatal deaths in connection withCS was 44% in 1978 - 1990, in the years 1991 - 1997 it increased to 61%. Out of which, the number ofdeaths in direct relation with surgery increased from 22 to 29%. By means of nation-wide enforcedprophylactics of tromboembolia and DIC, the lethality in direct relation with CS was reducedfrom 0,44‰ in the years 1988-90 down to 0,24‰ in the years 1991-97. Total lethality 0,49‰ in thelast five years is 4,4 times higher than after a total number of deliveries, which is the mainargument against further unreasonable growth of CS, and for improvement of general surgicalconditions in the nation wide perspective.

Key words:
caesarean section, maternal death, lethality