Causas externas e mortalidade materna: proposta de classificacao

Abstract

OBJECTIVE:To analyze deaths from external causes and undefi ned causes in women of childbearing age occurring during pregnancy and early postpartum. METHODS:The deaths of 399 women of childbearing age, resident in Recife, Northeastern Brazil, in the period 2004 to 2006, were studied. The survey utilized the Reproductive Age Mortality Survey method and a set of standardized questionnaires. Data sources included reports from the Institute of Legal Medicine, hospital and Family Health Strategy records and interviews with relatives of the deceased women. External causes of death during pregnancy were classifi ed according to the circumstance of death, using the O93 code (ICD) and maternal mortality ratios before and after the classifi cation were calculated. RESULTS:Eighteen deaths during pregnancy were identifi ed. The majority were aged between 20 and 29, had between 4 and 7 years of schooling, were black and single parents. Fifteen deaths were classifi ed using the O93 code as pregnancy related death (13 for homicide -code 93.7; 2 by suicide -code 93.6) and three were classifi ed as indirect obstetric maternal deaths (one homicide -code 93.7 and two by suicide -code 93.6). There was an average increment of 35% in the RMM after classifi cation. CONCLUSIONS:Deaths from undefi ned causes in and in early postpartumdid not occur by chance and their exclusion from the calculations of maternal mortality indicators only increases levels of underreporting.

Aborto e saúde no Brasil: desafios para a pesquisa sobre o tema em um contexto de ilegalidade

“…Considering the illegality of the practice, it is possible that delays in receiving care and complications that result in death after 42 days (delayed death) facilitate its omission as an immediate cause in the DC, favoring under-reporting of abortion as a cause of maternal mortality. Additionally, violent causes of death, such as homicide and suicide, which are potentially related to pregnancy, may be under-reported, since they do not compose the numerator when calculating MMR 58 .…”

Maternal Mortality Profile: An Integrative Literature Review / Perfil da Mortalidade Materna: Uma Revisão Integrativa da Literatura

“…16,18 Regarding the schooling, the lower the maternal mortality ratio (A1-A2-A6), 14,15,19 the higher the proportion of schooling found in women with first or incomplete first degree, 24 (42.9%) (A5), 18 and (10.3%) of the women presented some type of schooling (A3-A4). 16,17 With regards to the obstetric history, it was verified that women had from one to three previous pregnancies, or even more. The prevalent type of delivery was cesarean delivery (A3-A5).…”

“…16 Results of this review point to the need for attention, due to the action of indirect factors, such as incorrect completion of the investigation records and the death certificate (A4, A7, A8). 17,20,21 Still, loss of medical records, lack information on them or damage to printed matter, information not specified in medical records or death certificates and under-registration (A2, A3, A4, A5). 15,18 The vital record of births and deaths is also biased in the international literature.…”

The tip of the iceberg: postpartum suicidality in Israel

“…Another problem is that under-reporting of suicide in general [ 66 , 67 ] and in the postpartum period specifically [ 20 , 68 , 69 ], is well known and may be attributed to misclassification, or stigma in some societies, as noted above. In Fuhr et al’s review [ 48 ], the rate rose from 1.00 to 1.68% when reclassifying the leading suicide methods from injury to suicide.…”