Maternal mortality in Bavaria between 1983 and 2000

Objective: This study was undertaken to identify the main causes of maternal mortality within a developed country to refocus and enhance the delivery of obstetric services. Study design: From January 1, 1983, to December 31, 2000, 309 maternal deaths occurring in Bavaria were documented and classified in a prospective observational study. The data sources were the civil registry, confidential reports by members of the Bavarian Society of Obstetrics and Gynecology, and public information. Direct obstetric death, indirect obstetric death, and coincidental death account for 164, 67, and 78 cases, respectively. They were expressed as the maternal mortality ratio (MMR: maternal deaths/100,000 live births) over the 18-year study period divided into three 6-year intervals 1983 to 1988, 1989 to 1994,and 1995 to 2000. Results: The direct obstetric mortality ratio (DOMR: direct obstetric deaths/100,000 live births) decreased from 11.3 in the study period 1983 to 1988 to 5.4 in the study period 1995 to 2000 (P < .0005), mainly because of a reduction in antepartal and intrapartal deaths. The main cause of direct obstetric death was thromboembolism, including amniotic fluid embolism, which remained unchanged over the study period; other causes of direct obstetric death decreased markedly but not significantly. Conclusion: Careful analysis of the Bavarian maternal mortality data identified postpartum maternal deaths to be unchanged during the study period. In particular, effective prevention and treatment of thromboembolism should be a prior focus for obstetric care. (C) 2004 Elsevier Inc. All rights reserved.