Maternal Mortality Related to Anesthesia : Can It be Prevented?

Abstract

Background : Maternal mortality is still a problem in developing countries like Thailand. However calculating the maternal mortality rate (MMR) from death certificates might underreport as in other parts of the world. Anesthesia has never been included as a cause of maternal death in Thailand. The objective of this study was to investigate the maternal mortality rate and the causes of maternal death and to see if there is any correlation between the maternal death and anesthetic practice.
Methods : Questionnaires were sent to the directors of 800 public hospitals all over Thailand asking for information in the year 2000. The results were then compared with the information obtained in the same way 12 years ago (1988).
Results : From 498 out of 800 hospitals (62%) that sent the questionnaires back, which included 358,481 births and 94 maternal deaths in the year 2000. This 62% response was then compared with 89% response in 1988. The MMR was decreased from 31.4:100,000 in 1988 to 26: 100,000 in 2000.The six leading causes of maternal death were hemorrhage, embolism, preeclampsia, AIDS, sepsis and anesthesia.in 2000. In 1988, anesthesia was also the sixth leading cause of maternal death. General anesthesia was still the most frequent choice of anesthesia for cesarean section (70-75 %), without the prophylactic use of 0.3 M sodium citrate and spinal anesthesia was used in only 24-27% in both periods. This due to anesthetic service in Thailand is mainly done by nurse anesthetists who are not allowed to give regional anesthesia. Removal of placenta using a mask anesthetic technique which has an aspiration risk was still used in some hospitals. The causes of deaths were all from general anesthesia, and were the result of difficult intubation and aspiration while there were no death as a result of using spinal anesthesia. In developed countries, spinal anesthesia is the major choice of anesthesia for cesarean section.
Conclusions : The MMR in Thailand is still high and some causes are preventable. Health care providers should pay attention and try to reduce it. Anesthesia is the sixth leading cause of maternal death mostly due to difficult intubation and aspiration during using general anesthesia for cesarean section. However the use of general anesthesia for cesarean section in Thailand is still high. To reduce the maternal mortality from anesthesia, spinal anesthesia should be promoted. If general anesthesia is needed, standard techniques to prevent pulmonary aspiration should be used.