Maternal Mortality in an Israeli Hospital: A Review of 23 Years

Despite scientific advances in obstetrics maternal mortality is still a serious problem in many countries. This paper analyzes the causes of maternal mortality in Kaplan Hospital since its opening in 1954 up to 1976. 27 women died during this period; total number of deliveries was 63997. The period was divided into 3: 1954-61 with a mean number of deliveries of 2386 per year; 1962-71 with a mean number of deliveries of 2308 per year; and 1972-76 with a mean number of deliveries of 4244/year. Maternal mortality for the 1st period was 4.9/10000; in the 2nd 4.3/10000 and in the last 3.0/10000. Confidence limits based on the Poisson distribution method was used to test for statistical significance. Causes of direct maternal death included: 1) vascular accidents (amniotic fluid embolism and disseminated intravascular clotting) which accounted for almost 1/3 of all cases; 2) infection; 3) EPH gestosis or toxemia of pregnancy; 4) hemorrhage; and 5) anesthesia. Indirect causes of death included cardiac cases followed by pulmonary embolism cerebrovascular andirenal diseases in decreasing order of importance. Older age and parity did not affect incidence of obstetric deaths. This report indicates a definite decline in maternal mortality for the 3 periods. The decline was attributed to liberal use of better antibiotics emphasis on aseptic techniques better antenatal care and well-equipped operating theaters. Nevertheless vascular accidents remain the major direct cause of maternal deaths. Further research should be done on vascular accidents and its prevention; a healthy respect for the use of ceasarian sections may also be helpful in reducing further maternal deaths.