Trends in maternal mortality in Hungary between 1978 and 2010

Abstract

Objective: We evaluated the trends of the last decades in maternal mortality in Hungary and compared Hungarian results with those of other European countries.

Study design: Cases of maternal death in Hungary during the study period from calendar year 1978 to 2010 were analyzed in a retrospective manner to characterize mortality distribution and to identify potential clinical or demographic predictors. Data in all cases were extracted both from the national Obstetric Registry operated by the National Institute of Gynecology and Obstetrics, from the Hungarian Central Bureau of Statistics and from the National Public Health and Medical Officer Service. Detailed clinical data were obtained based on obligatory reporting by individual clinical institutions.

Results: The annual maternal mortality rate (MMR) was 26.7 per 100,000 live births in the period 1978-1987 and declined significantly to 10.9 per 100,000 live births in the period 1997-2010. In the period 1988-1996 (with missing associated clinical and demographic data) the MMR was 16.4 per 100,000 live births. The proportion of delivery-associated causes of death increased significantly between the two study periods from 49.4% to 62.9% (p<0.05). Among obstetric causes of death, the rate of thromboembolism showed a significant increase, while there was a trend toward a decline in rate of maternal deaths attributable to hemorrhagic shock. Among medical causes of death not directly attributable to obstetric complications, the rate of renal and gastrointestinal etiologies declined significantly throughout the study periods.

Conclusions: We observed a marked decline in maternal mortality during the last few decades in Hungary. Recent changes in mortality distribution highlight current characteristics of pregnancy care in Hungary and may help identify strategies for future improvement.

Keywords: Indirect causes of maternal death; Maternal mortality; Obstetric causes of maternal death; Thromboembolic complications of pregnancy.