Maternal Mortality in Bahrain with Special Reference to Sickle Cell Disease

EDITORIAL COMMENT: This paper reports an analysis of 37 maternal deaths in a predominantly Arab population. Bahrain has excellent obstetric hospitals but not all patients avail themselves of these facilities — a situation not unknown in so called developed countries! Sickle cell disease has a maternal mortality rate of about 2% in Bahrain and accounted for 12 of the 37 deaths; the information regarding these cases should interest readers who have little experience of this important disease. The authors set high standards for themselves in their assessment of whether the cases considered had avoidable factors that might have minimized the risk of death. The maternal mortality rate was 33.9 per 100,000 livebirths; this figure is about double that in Australia, although it should be noted that incidental deaths (e.g. accidents, suicides, murders, malignancies), which account for about 30% of maternal deaths in Australia, were not considered. The authors' task was not made easier by the fact that autopsies were not performed because of the prevailing religious beliefs. Summary: The maternal mortality in Bahrain during the 10‐year period, 1977 ‐ 1986, was 33.9 per 100,000 livebirths; the second 5‐year period showed a significant reduction (26.9) compared to the first 5‐year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.