الفهرس 
Maternal mortality,the scope of the problemOnly 14 pages are availabe for public view
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Abstract
Maternal mortality is one of the indicators of the quality of the health services. It is also considered the nightmare for obstetricians. Maternal death has a deep impact on the social and the economic level. The developing countries have the larger proportion of maternal deaths where 99% of maternal deaths occur in them.
Maternal mortality can be measured in various methods; the most popular of them is maternal mortality ratios (MMR). MMR is the number of maternal deaths per 100,000 live births.
The great discrepancy in MMR between developing and developed countries is attributed to many social, economic, political and medical factors. Lack of equipments, unavailability of nearby medical facility, ignorance about danger signs, lack of antenatal care programs, poor management, all of these and others are considered crucial factors leading to that great discrepancy.
Even the cause of death is different between developing and developed countries, where haemorrhage is considered the major cause of death in developing countries, while thromboembolism is considered the major cause of death in developed countries.
One of the most important issues related to maternal death is substandard care. Substandard care is defined as some of the underlying factors which may have produced a low standard of care for the patient. This includes situations produced by the action of the woman herself, or her relatives, which may be outside the control of the clinicians. It also takes into account shortage of resources for staffing facilities; and administrative failure in the maternity services and the back-up facilities such as anesthetic, radiological and pathology services.
Egypt is considered one of the leading countries worldwide in reducing maternal mortality. In 1992 MMR was 164 per 100,000 that DROPped to 84 per 100,000 in 2000. In 2007 the MMR reached 55 per 100,000 which is considered one of the best among developing countries. This big decline in MMR is not just due to improving the health services and avoiding elements of substandard care, but it is also due to the national maternal mortality surveillance system that started in the year 2000. Since then accurate numbers are collected about the maternal mortality, however this system is still defective as regarding the circumstances of maternal death.
In our retrospective study we collected the information about maternal deaths in Ain Shams University Maternity Hospital and El-Galaa Maternity Hospital in the years 2007 and 2008. Data were collected in a form inspired by the forms of the Confidential Enquiry into Maternal Death (CEMD).
Total number of deaths was 48 cases, forty one were included in the study and 7 were excluded because there files were missing. Data collected were analyzed statistically and they showed MMR of 44.5 per 100,000, compared to national MMR of 55 per 100,000 and CEMD MMR of 13.95 per 100,00. This discrepancy was attributed to many factors such as inadequate antenatal care programs, lack of equipments in central hospitals, poor compliance to protocols and guidelines, and inaccurate implementation of the auditing system.