What are the causes and what are the ways to avoid them?

A recent Public Health France survey reveals that between 2016 and 2018, a maternal death occurred every 4 days in France from a cause linked to pregnancy, childbirth or postpartum. What is maternal death? What are the causes ? Are there ways to avoid it? We take stock.

What is maternal death?

Maternal death means the death of the mother during pregnancy or within 42 days after the end of the pregnancy. Maternal death is neither accidental nor fortuitous and can be linked to a specific cause, or a cause aggravated by the pregnancy or even a cause aggravated by the care required by the pregnancy.

We distinguish two categories of maternal deaths :

1. Deaths by direct obstetric cause which follow obstetric complications (pregnancy, labor and postpartum), interventions or the omission of treatment or even inadequate treatment.
2. Deaths by indirect obstetric cause which are the consequence of a pre-existing illness or a condition that appeared during pregnancy aggravated by the physiological effects of pregnancy.

According to a recent report from Public Health France, from 2016 to 2018, we deplored in France one maternal death every 4 days from a cause linked to pregnancy, childbirth or postpartum.

To know ! Published on April 3, this report is based on data from the Confidential National Survey on Maternal Deaths (ENCMM).

Maternal death: causes and risk factors identified

More specifically, during this period, 272 maternal deaths occurred during pregnancy or in the year following the end of pregnancy. 197 of these deaths meet the international definition of maternal deaths, meaning they occurred within 42 days of the end of the pregnancy.

From main causes of maternal mortality up to one year, let’s mention the suicides who now occupy first place (17%) ahead of cardiovascular illnesses (14%). Cardiovascular diseases nevertheless remain the leading cause of mortality during the 42 days after the end of pregnancy. As for obstetric hemorrhages, if ten years ago they represented the leading cause of maternal mortality at one year, they have moved to 5^e position and show a stable level over the period 2016-2018.

This study also took into account the sociodemographic characteristics of the deceased women. For example, the risk of mortality was thus found to be higher:

• In women aged 35 to 39: with a mortality risk multiplied by 2.6 compared to women aged 20 to 24.
• In women over 40 years old: with a mortality risk multiplied by 5 compared to women aged 20 to 24.
• At the women suffering from obesity: with a risk doubled compared to the general population of pregnant women.
• Among women living in overseas departments and regions: with a risk doubled compared to the metropolitan average.

Towards a reduction in the number of maternal deaths?

For the authors of this study, reducing the number of maternal deaths is possible since 60% of maternal deaths are “probably” (17%) or “possibly” (43%) preventable. Among the factors most often involved in these preventable deathslet us quote:

• The inadequacy of the care provided.
• A lack of organization of care.
• A lack of interaction between the woman and the healthcare system.

Based on these observations, the experts in charge of this study extracted 30 key messages with the aim of to improve prevention, screening and coordination of care. They emphasize the importance of researching and identifying possible risk factors for perinatal depression in pregnant women as well as the need to monitor them until postpartum.

Déborah L., Doctor in Pharmacy

Sources