CMAJ • May 9, 2006; 174 (10). doi:10.1503/cmaj.1060058.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Maternal mortality: an important priority

Sharon Bartholomew* and Rob Liston{dagger}

*Co-chair, CPSS Maternal Health Study Group, Public Health Agency of Canada, Ottawa, Ont.; {dagger}Co-chair, CPSS Maternal Health Study Group, Department of Obstetrics, Children's and Women's Health Centre of British Columbia, Vancouver, BC

We were pleased to read Donna Stewart's analysis of maternal mortality in Canada1and we fully agree that prevention of maternal mortality and morbidity requires a broad view. Dr. Stewart's concern about the limited knowledge of maternal deaths in Canada is echoed in our 2004 document on maternal mortality and severe morbidity in Canada.2 The reported maternal mortality ratio of 6.1/100 000 live births consists of direct and indirect obstetric deaths, and excludes maternal deaths that occur beyond 42 days after the termination of the pregnancy and those that occur from "accidental or incidental causes."3 We gathered some information on deaths in these categories, but generally in Canada this information is not well captured. This leads to under-ascertainment of maternal deaths due to unintentional injury, violence and mental illness.

Through the Canadian Perinatal Surveillance System (CPSS), the Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada are continuing to work with provincial and territorial governments to improve the surveillance and review of maternal deaths. The number of provincial, territorial or regional maternal death review committees is increasing. The CPSS and partners are working on measures to improve ascertainment of maternal deaths through the vital statistics system. In addition, the implementation of ICD (International Classification of Diseases)-10, with its code of "late maternal death" for those direct and indirect obstetric deaths that occur between 42 days and one year after the end of the pregnancy, should improve ascertainment of these deaths.

REFERENCES

  1. Stewart DE. A broader context for maternal mortality. CMAJ 2006;174: 302-3.[Free Full Text]
  2. Health Canada. Special report on maternal mortality and severe morbidity in Canada. Enhanced surveillance: the path to prevention. Ottawa: Public Health Agency of Canada; 2004.
  3. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 9th revision, vol. 1. Geneva: WHO; 1977.




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