Violent deaths:: the hidden face of maternal mortality

Objective To review pregnancy-related deaths due to injuries, to identify the characteristics of these women and to compare the magnitude of injury-related maternal deaths to that of other causes of maternal death. Design A retrospective study was performed during a five-year period (1991-1995), covering deaths from injuries, including suicide, homicide and accidents in Maputo, Mozambique. Setting Department of Forensic Medicine at the Maputo Central Hospital, Mozambique. Population The pregnant or recently pregnant (post-abortion and postpartum) population of Maputo city, the national capital of Mozambique. Twenty-seven cases of pregnancy-related deaths caused by injuries were identified. Main outcome measures Proportion of deaths due to homicide, suicide, and accidents in pregnant women or within 42 days after termination of pregnancy. Results Ten cases were due to alleged homicide, nine to alleged suicide and six to alleged accident. Fifty-nine percent (16/27) of women suffering an injury-related maternal death were younger than 25 years of age. Eighty-five percent of pregnancies were less than 28 weeks of gestational age. The magnitude of the problem of violence-related maternal deaths compares with the magnitude of pregnancy-induced hypertension as the fourth cause of maternal death at Maputo Central Hospital. Conclusion The contribution of violence-related deaths to maternal mortality is significant and must not be neglected.