Résumé : Maternal mortality trends between 1960 and 1990 for Sao Paulo district, the interior, and Brazil were described and compared to official statistical data corrected in special studies at 3 key points in time. Cause of death data needed correction due to classification changes in the periods 1960-68, 1969-78, and 1979-90. The results reveal that maternal mortality declined from about 100/100,000 live births in the early 196-s to lower levels until 1985, after which there was a slight increase. By 1990, maternal mortality was higher than in other parts of the country, when during the 1960s maternal mortality was lower in the municipal area of Sao Paulo. Data were constructed to reflect rates for the periods 1960-62, 1970-72, 1980-82, and 1988-90. Comparisons with other parts of the state showed a slower reduction in maternal mortality in Sao Paulo. For example, between the first and last periods, mortality declined by 53.7% in Sao Paulo and 70.8% in the rest of the state. Survey data differ from official estimates for the district of Sao Paulo in the direction of being twice as high as official figures. Careful examination of the data showed that registration had included deaths by place of occurrence rather than residence before 1968. In the corrected data on cause of death, maternal deaths due to abortion complications were found to be 19.5% of all maternal deaths in 1962-63, 25.0% in 1974-75, and 10.7% in 1986. The explanation for the trend was given as a change in medical practice and the widespread use of contraceptives. The largest cause of maternal mortality was complications of pregnancy, which increased from 28/100,000 live births in 1962-63 to 48.8/100,000 in 1974-75 and 64.0/100,000 in 1974-75 and 64.0/100,000 in 1986. The leading causes of these deaths were toxemia of pregnancy (22.2% of pregnancy complication and 14/2% of maternal mortality) and parasitic infectious diseases (8.9% of maternal mortality). There was a decline after 1974-75 in pregnancy complications in delivery and the puerperium. In 1986, pulmonary embolism and puerperal infections were the leading causes of puerperium-related maternal mortality. In 1991, a Committee for the Study and Prevention of Maternal Mortality was established and found that many maternal deaths could have been avoided with an improvement in the quality of medical services.
Site web : http://publications.paho.org/english/moreinfo.cfm?Product_ID=557