Hospitalized delivery and maternal deaths from obstetric hemorrhage in China from 1996 to 2006

Abstract

Objectives: To evaluate the role of hospitalized delivery in reducing maternal deaths from obstetric hemorrhage in urban and rural areas of China.

Design: Longitudinal, retrospective study and review of maternal deaths based on data from the Maternal and Child Health Surveillance System (MCHSS).

Setting: The surveillance areas of Maternal and Child Health in China from 1996 to 2006.

Sample: A total of 6 259 336 live births and 1 418 maternal deaths from hemorrhage.

Methods: Data on maternal deaths were retrieved from the MCHSS. The leading factors contributing to these deaths were reviewed by three committees.

Main outcome measures: Maternal mortality ratio (MMR), relative risk (RR), leading factors contributing to deaths.

Results: The MMR due to hemorrhage significantly decreased with increasing hospitalized delivery rates in rural areas, but it did not decrease in urban areas. The RR of maternal deaths from hemorrhage in women with non-hospitalized delivery in comparison to hospitalized delivery were 2.52 (95% confidence interval (CI): 1.71~3.70) in urban areas, and 5.52 (95% CI: 4.79~6.36) in rural areas. The level of knowledge and skills of medical professionals was the leading factor contributing to 79.6% (urban) and 81.0% (rural) of the deaths during hospitalized delivery.

Conclusion: The quality of obstetric care in hospitals has become one of the most important factors influencing the risk of maternal deaths from hemorrhage in China. The knowledge and skills of medical professionals need to be improved, especially in primary hospitals.