Misreporting of maternal mortality in Puerto Rico
Comas, A.; Navarro, A.; Conde, J.; Blasini, I.; Adamsons, K.
Boletin de la Asociacion Medica de Puerto Rico 82(8): 343-346
1990
ISSN/ISBN: 0004-4849 PMID: 2261025 Document Number: 700027
The paper describes a study conducted in Puerto Rico focusing on the degree of underreporting of maternal deaths in the national vital registration system for the year 1982. Commencing with 886 registered deaths to women aged 10-49 years, the investigators reviewed death certificates, medical records and autopsy reports in order to identify those fatalities where the cause fell within the category of maternal death according to the International Classification of Diseases, ICD-9 (ninth revision). All deaths to these causes during pregnancy and up to 90 days after the termination of pregnancy were regarded as maternal. Almost a half (43%) of the initial 886 deaths were eliminated at an early stage since the registered causes were judged unlikely to be pregnancy-related. Of the 503 deaths for which death certificates were obtained, medical records and/or autopsy reports were examined for just over a half (54%). The investigators identified 28 maternal deaths compared with 8 in the vital registration system. This discrepancy results in maternal mortality ratios (maternal deaths per 100 000 livebirths) of 40.4 and 11.5, respectively. Moreover, only 15% of the misclassified maternal deaths identified in this study were apparent from inspection of the death certificate alone; the vast majority could be detected only by detailed review of medical records. The degree of underreporting of maternal deaths in the vital registration system (71%) was virtually the same as that found in a study in Puerto Rico employing different procedures which was conducted in 1978-79 (73%). The authors propose measures to improve surveillance for maternal deaths.[The limitations on studies of this nature relate primarily to the comparatively small proportion of all deaths to women in the reproductive years for which adequate records are available for review and, where necessary, reclassification of the cause of death. Similarly, use of the vital registration system as the starting point for identifying deaths for follow-up has been found in other developing-country contexts to lead to serious underestimation of the level of maternal mortality. This paper thus provides a minimal estimate of the degree of underreporting in Puerto Rico and highlights the importance of using multiple sources of information in studies of maternal mortality.]Wendy Graham.
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