[Maternal mortality estimation in France, according to a new method].
OBJECTIVE
Ten years after implementation of maternal mortality monitoring in France, we established a new estimate of the current maternal mortality ratio (MMR) and revisited maternal death data collection.


METHODS
Linkages were set up between female deaths and childbirths and between female deaths and causes of death. Information provided by confidential inquiries into maternal deaths carried out by the National Committee for maternal mortality study was added. The World Health Organization (WHO) definitions were used for maternal death and maternal mortality ratio. The study concerned deaths occurring in 1999. Results were compared with data from 1989.


RESULTS
The official data showed 20% fewer maternal deaths than our inquiry. Estimated from our data, the MMR was 9 per 100000 live births in 1999. Direct obstetric causes were more often recorded than indirect causes. Hemorrhage was the leading obstetric cause of maternal death (21%). In comparison with the 1989-90 data, the underestimation of maternal deaths and maternal mortality ratios are improving (from 18 to 9 per 100000).


CONCLUSIONS
These results, obtained while the mean maternal age at childbirth increased regularly, are interpreted as a sign of improvement in care. But the persistence of post partum hemorrhages as the leading cause of maternal death and the high rate of avoidable deaths, disclose important targets for further progress.
INSERM, Unité 149, Recherches épidémiologiques en santé périnatale et santé de la reproduction, Maternité Hôpital Tenon, 4, rue de la Chine, 75020 Paris. mh.bouvier-colle@tnn.ap-hop-paris.fr
M-H
MH
Bouvier-Colle
C
C
Deneux
E
E
Szego
C
C
Couet
E
E
Michel
N
N
Varnoux
E
E
Jougla
D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D014944:World Health Organization