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Maternal death is defined as "The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes."〔 The world mortality rate has declined 45% since 1990, but still 800 women die every day from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) this is equivalent to “about one woman every two minutes and for every woman who dies, 20 or 30 encounter complications with serious or long-lasting consequences. Most of these deaths and injuries are entirely preventable.” 〔http://www.unfpa.org/maternal-health〕 UNFPA estimated that 289,000 women died of pregnancy or childbirth related causes in 2013. 〔http://www.unfpa.org/maternal-health〕 These causes range from severe bleeding to obstructed labour, all of which have highly effective interventions. As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality ratio has fallen from 380 maternal deaths per 100,000 live births in 1990 to 210 deaths per 100,000 live births in 2013. This has resulted in many countries halving their maternal death rates. 〔http://www.unfpa.org/maternal-health〕 While there has been a decline in world-wide mortality rates, much more has to be done. High rates still exist, particularly in impoverished communities with over 85% living in Africa and Southern Asia. 〔http://www.unfpa.org/maternal-health〕 The effect of a mother’s death results in vulnerable families and their infants, if they survive childbirth, are more likely to die before reaching their second birthday. 〔http://www.unfpa.org/maternal-health〕 ==Causes== Factors that increase maternal death can be direct or indirect. Generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death.〔Khlat, M., & Ronsmans, C. (2009). Deaths Attributable to Childbearing in Matlab, Bangladesh: Indirect Causes of Maternal Mortality Questioned. American Journal Of Epidemiology, 151(3), 300-306.〕 that is a pregnancy-related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. Fatalities during but unrelated to a pregnancy are termed ''accidental'', ''incidental'', or nonobstetrical maternal deaths. The most common causes are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labour (6%). Other causes include blood clots (3%) and pre-existing conditions (28%). Indirect causes are malaria, anaemia,〔The commonest causes of anaemia are poor nutrition, iron, and other micronutrient deficiencies, which are in addition to malaria, hookworm, and schistosomiasis (2005 WHO report p45).〕 HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it. Sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers,〔http://www.who.int/mediacentre/factsheets/fs348/en/〕 especially adolescents aged 15 years or younger.〔Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349〕 Adolescents have higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to maternal death.〔 Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death.〔''(K. J., & Eastwood, J. G. (2014). Social determinants of maternal self-rated health in South Western Sydney, Australia. BMC Research Notes, 7(1), 1-12. doi:10.1186/1756-0500-7-51 )''〕 Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths. Unsafe abortion is another major cause of maternal death. According to the World Health Organization, every eight minutes a woman dies from complications arising from unsafe abortions. Complications include hemorrhage, infection, sepsis and genital trauma 〔(L. B., & Nour, N. M. (2009). Unsafe abortion: unnecessary maternal mortality. Reviews in obstetrics and gynecology, 2(2), 122. )〕 Globally, preventable deaths from improperly performed procedures constitute 13% of maternal mortality, and 25% or more in some countries where maternal mortality from other causes is relatively low, making unsafe abortion the leading single cause of maternal mortality worldwide.〔(Fertility Regulation and Reproductive Health in the Millennium Development Goals: The Search for a Perfect Indicator )〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Maternal death」の詳細全文を読む スポンサード リンク
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