title: External causes and maternal mortality: proposal for classification.
abstract: OBJECTIVE
  To analyze deaths from external causes and undefined causes in women of childbearing age occurring during pregnancy and early postpartum.
  
  
  METHODS
  The deaths of 399 women of childbearing age, resident in Recife, Northeastern Brazil, in the period 2004 to 2006, were studied. The survey utilized the Reproductive Age Mortality Survey method and a set of standardized questionnaires. Data sources included reports from the Institute of Legal Medicine, hospital and Family Health Strategy records and interviews with relatives of the deceased women. External causes of death during pregnancy were classified according to the circumstance of death, using the O93 code (ICD) and maternal mortality ratios before and after the classification were calculated.
  
  
  RESULTS
  Eighteen deaths during pregnancy were identified. The majority were aged between 20 and 29, had between 4 and 7 years of schooling, were black and single parents. Fifteen deaths were classified using the O93 code as pregnancy related death (13 for homicide - code 93.7; 2 by suicide - code 93.6) and three were classified as indirect obstetric maternal deaths (one homicide - code 93.7 and two by suicide - code 93.6). There was an average increment of 35% in the RMM after classification.
  
  
  CONCLUSIONS
  Deaths from undefined causes in and in early postpartumdid not occur by chance and their exclusion from the calculations of maternal mortality indicators only increases levels of underreporting.
authors.affiliation: Universidade Federal de Pernambuco, Departamento de Medicina Preventiva e Social, Programa de Pós-Graduação Integrado em Saúde Coletiva, RecifePEBrazil.
authors.forename: Mércia Maria Rodrigues
authors.initials: MM
authors.lastname: Alves
authors.forename: Sandra Valongueiro
authors.initials: SV
authors.lastname: Alves
authors.forename: Maria Bernadete de Cerqueira
authors.initials: MB
authors.lastname: Antunes
authors.forename: Dirce Luiza Pereira dos
authors.initials: DL
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D016021:Epidemiologic Studies; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D063130:Maternal Death / Q000145:classification / Q000209:etiology* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult