title: The etiology of maternal mortality in developed countries: a systematic review of literature.
abstract: OBJECTIVE
  To review the literature about MD in developed countries.
  
  
  METHODS
  A search in PubMed, EMBASE, Medline and reference lists was performed. Key words: maternal death/mortality, pregnancy death and obstetric/maternity care. Articles were selected if they reported the cause of death per livebirths, were performed in developed countries and unselected population, classified MD by the World Health Organization. Maternal age, cause of MD, time of MD (antepartum, intrapartum, postpartum) and delivery mode were abstracted. MD was expressed as maternal mortality ratio (MMR). PRISMA guidelines were followed.
  
  
  RESULTS
  Twelve articles provided data from 1980 to 2007. The MD rate was 9,750 in 75,560,683 livebirths (MMR: 12.90). MD was direct in 6,791 women (MMR: 8.98), being postpartum hemorrhage the leading cause, and indirect in 2,786 women (MMR: 3.68), with cardiovascular disease as the main cause. The remaining 173 deaths (MMR: 0.22) were unexplained. Maternal age >45 years, vaginal delivery, postpartum period increased the risk of MD. MD reduced over time in all countries except in the Netherlands and USA.
  
  
  CONCLUSIONS
  Conditions leading to hemorrhage warrant strict management. The risk of an apparently healthy woman to die during motherhood is 0.22 out of 100,000 livebirths.
authors.affiliation: Department of Gynecology, Obstetrics and Neonatology, University of Bari, Via Celentano 42, 70121 Bari, Italy. acristinarossi@yahoo.it
authors.forename: A
authors.initials: A
authors.lastname: Cristina Rossi
authors.forename: Patrick
authors.initials: P
authors.lastname: Mullin
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D019049:Developed Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008423:Maternal Age; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality*; D011247:Pregnancy