CARACAS, Monday May 07, 2012
103RD ANNIVERSARY | The enemies

Maternal mortality can be prevented

Pregnancy poses risks that are beyond the control of future mothers; the good news is that 80% of these risks can be avoided

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Monday May 07, 2012

The fact that giving birth is one of the most beautiful experiences in the life of a woman is indisputable; however, it is also true that it is one of the greatest reasons for concern. And justifiably so: pregnancy poses risks that are beyond the control of future mothers; the good news is that 80% of these risks can be avoided. It is not only about the baby's good health; wrongly understood dangers could bring about the mother's death.

Jairo Fuenmayor, professor of Clinical Obstetrics at the Central University of Venezuela and member of the Venezuelan Obstetrics Association, explained that a recent research work conducted by the Association revealed the three main causes of death among pregnant women in Venezuela: hemorrhagic disorders, high blood pressure and infections.

The main risk factors that increase the probability of suffering these conditions are anemia or malnutrition, lack of prenatal control and pregnancy at extreme ages, i.e. less than 20 years of age or more than 40.

To avoid complications, Fuenmayor adds, early diagnosis and regular prenatal control are fundamental; he also recommends that pregnant women should visit at least once their doctor during the first seven months of pregnancy and more frequently (at least twice) in the eighth and ninth months.

Latent Danger

The main cause of maternal mortality in Venezuela, hemorrhage, is a pregnancy-related complication and can be attributable to diverse causes, such as uterine hypotonia; this condition occurs when the uterus tone decreases after birth and bleeding appears.

Hemorrhage can also occur when rests of placenta remain inside the uterus or when the mother, at the process of giving birth, develops uterine fibromatosis, i.e. the uterus does not contract properly and bleeds.

Concerning pregnancy-related high blood pressure, also known as preeclampsia, or infections, Dr. José Félix Oletta, former Minister of Health and member of the board of the Network of Scientific Medical Societies of Venezuela, states that these conditions develop due to the lack of prenatal surveillance and control. "Doctors are able to identify when a pregnant woman has proteins in the urine, vagina infection or blood pressure-related disorders. If a woman at the time of giving birth is not aware of the potential risks, she is helpless and forces the physician to apply emergency maneuvers that entail expenses and increased danger."

According to the Economic Commission for Latin America and the Caribbean (ECLAC), less than 40% of Venezuelan pregnant women are undergoing prenatal control, vs. an average of 50% in Latin America.

According to Oletta, there is an additional risk factor that has gained significance in a worrying manner in Venezuela: 25% of future mothers in Venezuela are adolescent. "If pregnant women are not physically or psychologically prepared to give birth, complications are going to be worse. When the mother dies, the whole family is impacted, because many times, the family structure is matriarchal and depends on the mother's health and wellbeing."

Nutritional control is also fundamental. In the modern world, diets followed by many women bring about imbalances in the amounts of hemoglobin, hematocrits and in the accumulation of energy reserves. Therefore, pregnant women are recommended to take iron and folic acid supplements.

Backward state

According to data released by the Network of Scientific Medical Societies, maternal mortality rate has not decreased in Venezuela as from 1998. Recent studies conducted by the Society report 377 maternal deaths in 2011 (the highest figure over 6 years); whereas, until February 18, 2012, the same study reported 48 deaths, twice higher than the same period in year 2011, for an increase of 4.3%. The states with the highest number of maternal death are: Carabobo, Anzoátegui, Zulia, Monagas and Barinas.

These figures are not accurate, Oletta explains, because they are obtained from the analysis and projection of the mortality yearbook released by the Ministry of Health, which presented its last statistic data in 2008. "Access to these indicators is very limited; they are published with significant delay. Furthermore, these figures are underestimated by 20% or more."

However, with or without an error margin, these figures are alarming. The maternal mortality index directly reflects the quality of the country's health systems and data evidences that they are in a critical condition.

According to the UN Millennium Development Goals, reducing maternal mortality is one of the fundamental goals, but Venezuela is far from attaining it.

Oletta explains that in 1990, maternal mortality was 58.9 per every 100 thousand live births. According to the goal, Venezuela should reduce that figure by 75% by 2015; this is, to 14 per every 100 thousand live births.

"Sadly, we are not moving in that direction. In 1998, we registered the lowest rate, with 51 maternal deaths per every 100 thousand live births and since then, it started to increase. Today, we have five times more than the goal set," Oletta pointed out.

The highest peak was observed in 2002, with an awful figure of 68 mothers dead per every 100 thousand live births. Now, figures are close to 70 deaths per every 100 thousand live births.

"Having a responsible behavior throughout pregnancy is fundamental. Women should not wait to be sick to visit the doctor; on the contrary, they have to be submitted to prenatal controls to identify risk factors. As long as prevention programs for pregnant women are not promoted, indicators are going to be a failure. This is the challenge for the current administration and for those that are to come," Oletta stated.

Translated by Álix Hernández