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Z Geburtshilfe Neonatol 2018; 222(04): 143-151
DOI: 10.1055/a-0607-2816
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Müttersterbefälle weltweit rückläufig, aber häufig vermeidbar!

Maternal Deaths Worldwide Falling – But Commonly Preventable
Werner Rath
1   Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Panagiotis Tsikouras
2   Department of Obstetrics and Gynecology, Alexandroupolis, Democritus University of Thrace, Greece
› Author Affiliations
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Publication History

eingereicht  05 March 2018

angenommen nachÜberarbeitung   05 April 2018

Publication Date:
25 June 2018 (online)

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Zusammenfassung

Laut WHO ist die mütterliche Mortalitätsratio von 1990 bis 2015 weltweit um 44% gesunken, aber immer noch sterben mehr als 300 000 Mütter, davon 99% in den Entwicklungsländern. In einigen Industrieländern ist die Inzidenz mütterlicher Sterbefälle in den letzten 20 Jahren sogar angestiegen. Die führenden Ursachen direkter Müttersterbefälle sind Blutungen (ca. ¾ davon postpartale Blutungen), Lungenembolien einschließlich Fruchtwasserembolien und hypertensive Schwangerschaftserkrankungen, die indirekter Müttersterbefälle kardiale Erkrankungen der Mutter. Der wichtigste Schritt zur Vermeidung von Müttersterbefällen ist die sorgfältige Evaluation jedes Todesfalls durch ein multidisziplinäres Komitee von unabhängigen Experten, gefolgt von einer im Konsensus getragenen Übereinkunft über die zugrundeliegende Todesursache, die Qualität der Versorgung und ob der Müttersterbefall vermeidbar war oder nicht. Die UK Confidential Enquiries into Maternal Deaths and Morbidity gelten international als Goldstandard zur Überwachung mütterlicher Sterbefälle. Unter Berücksichtigung von 11 Studien aus verschiedenen Industrieländern sind ca. 50% aller direkten Müttersterbefälle (Bereich: 26–75%) potentiell vermeidbar, am häufigsten Sterbefälle infolge postpartaler Blutungen und hypertensiver Schwangerschaftserkrankungen, am wenigsten Sterbefälle infolge Fruchtwasserembolien. Der entscheidende Punkt ist, aus Fehlern, die zum mütterlichen Tod geführt haben, zu lernen. Jede geburtshilfliche Abteilung sollte sorgfältig prüfen, ob und wo Verbesserungsbedarf besteht, um schwere mütterliche Morbidität und Mortalität zu vermeiden.

Abstract

According to data from the WHO, maternal mortality ratio has dropped worldwide by 44% between 1990 and 2015, yet more than 300,000 mothers still die annually, about 99% of them in the developing countries. In some developed countries the incidence of maternal deaths has even increased during the past 2 decades. The leading causes of direct maternal deaths are haemorrhage (nearly 3-quarters from postpartum haemorrhage), pulmonary embolism including amniotic fluid embolism, and hypertensive disorders of pregnancy; the leading cause of indirect maternal deaths is cardiac disease of the mother. The most important step to prevent maternal deaths is the accurate evaluation of each death by a multidisciplinary committee of independent experts, followed by consensus-based agreement on the underlying cause of death, the quality of care, and whether or not the death was preventable. The UK Confidential Enquiries into Maternal Deaths and Morbidity are internationally recognized as the ‘gold standard’ in maternal mortality surveillance. Considering the 11 studies from different developed countries, nearly 50% of direct maternal deaths (range: 26–75%) are potentially preventable, most often those due to postpartum haemorrhage and hypertensive disorders of pregnancy, and the fewest of all due to amniotic fluid embolisms. The crucial point is to learn from failures leading to maternal deaths: each obstetric unit should scrutinise if and where the need for improvement exists to prevent severe maternal morbidity and mortality.

Schlüsselwörter

Müttersterbefälle - Inzidenz - Ursachen - substandard care - Vermeidbarkeit

Key words

maternal deaths - incidence - causes - substandard care - preventability
 

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