The impact of regional anaesthesia on maternal mortality

Abstract

The World Health Organisation estimates that world-wide about 600 000 women die each year from pregnancy related causes, and 99% of these deaths occur in the developing world.^1,2 The high maternal mortality rates (MMR) in the third world are related to poverty, lack of clean water, starvation, female illiteracy, abortion and above all, lack of skilled care.^1,3 MMR in the third world is now 100–200 times higher than in industrialised countries, but similar to that in the UK before 1935. For the following 50 years MMR declined exponentially in the UK with a half-life of 10 years,⁴ but since the 1980s it has been fairly static. The Confidential Enquiry into Maternal Deaths (CEMD) shows that the maternal mortality rate for direct and indirect deaths in the United Kingdom is now at 12.2 per 100 000 maternities⁵ while according to death certification (the means whereby MMR is derived internationally) it is 7.4 per 100 000. This MMR is about the median for first world countries. The CEMD, which began in 1952, is the longest running example of detailed medical audit in existence. It therefore seems reasonable to base any discussion of causes of death on the information it contains.