Numerical data from the United States as a whole show a decline in the maternal death rate (per 10,000 live births) from 11.6 in 1946 to 4.0 in 1956. The figures for New York City and Bronx County show a comparable decline. A detailed study of the Bronx data has been made in order to identify the areas in which obstetrics has made its greatest advances and those on which attention should be concentrated in the future. Infection has shown the greatest reduction in maternal mortality rates, but it is still a leading cause of death because of the persistence of criminal abortion. There has been significant reduction in mortality from hemorrhage, heart disease, and anesthesia. The reduction of mortality from toxemia has been gradual over a period of many years, but further improvement must await the discovery of the cause of toxemia. Oxytocin therapy has facilitated the solution of some difficult obstetric problems, and cesarean section has displaced a number of dangerous manipulations. Improvements in the teaching of obstetrics, the control of labor, and the facilities in hospitals should lead to still further reduction of maternal mortality.
Klein MD, Clahr J. FACTORS IN THE DECLINE OF MATERNAL MORTALITY. JAMA. 1958;168(3):237–242. doi:10.1001/jama.1958.03000030009002
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