Search

Reports were received on 364 of the unknown number of maternal deaths that occurred in Papua New Guinea during the two years, 1 January, 1971 to 31 December, 1972. Postpartum haemorrhage accounted for 39 per cent of the deaths, puerperal sepsis for 19 per cent and associated conditions for 14 per cent. In 13 per cent of cases the cause of death could not be ascertained. Obstructed labour caused 4 per cent of the deaths, ruptured uterus 4 per cent, antepartum haemorrhage 3 per cent and abortion 3 per cent. Three deaths were due to miscellanous causes. It is possible that three of the deaths (0.8 per cent of the total) in the cause unascertained group were due to toxaemia of pregnancy. In the coastal districts the major cause of death was postpartum haemorrhage (53 per cent) and the major high-risk factor was grand multiparity (5 or more). In the highlands the major cause of death was puerperal sepsis (41 per cent) and the major high-risk factor was nulliparity. About 50 per cent of all pregnant women in Papua New Guinea are seen at antenatal clinic and about 25 per cent of all births occur in hospital or heath centre. Forty-four per cent of the women who died (abortion excluded) were seen at antenatal clinic and 18 per cent were delivered in hospital or health centre. High-risk factors were present in 87 per cent of women who were seen at antenatal clinic, but only 28 per cent of these high-risk women were delivered in hospital or health centre. Extension of the antenatal services will not result in a major reduction in maternal mortality unless high-risk factors are recognised and unless high-risk mothers can be persuaded to have their babies in hospital or health centre.

A study was made of the 67 still-births and the 58 neonatal deaths that occurred among the 3,516 viable infants (birth weight 1,000 g. or more) that were born to public patients of the obstetric units of Port Moresby General Hospital and St. Therese's Maternity Hospital during the year 1972. The combined stillbirth and neonatal mortality rate was 35.5 per 1,000 births. The adverse effects of lack of antenatal care, delivery outside hospital, high parity, maternal anaemia, mulitple pregnancy, and low birth weight are demonstrated. Low birth weight (1,000 to 2,200 g.) of unknown cause accounted for 24.0 per cent of the deaths. In 16,8 per cent of cases the birth weight was more than 2,200 g. and the cause of death was unknown. Birth trauma accounted for 19.2 per cent of the deaths, congenital malformation for 11.2 per cent, antepartum haemorrhage for 11.2 per cent, toxaemia for 10.4 per cent, and maternal disease for 3.2 per cent. There were miscellaneous causes in 4.0 per cent of cases. Approximately 75 per cent of the deaths were considered to be the result of unfavourable factors in the mother's environment. Approximately 14 per cent were primarily the result of obstetric complications and might have been avoided by a higher standard of obstetric care. Improving the standard of obstetric care that is presently available in Port Moresby would probably reduce the perinatal mortality rate by not more than 5 per 1,000.