Maternal tetanus : magnitude, epidemiology and control of a neglected cause of maternal mortality

It includes postpartum or puerperal tetanus resulting from septic procedures during delivery, postabortal tetanus resulting from septic abortion, and tetanus incidental to pregnancy, resulting from any type of wound during pregnancy. The magnitude of its contribution to maternal mortality in developing countries is unclear and probably underestimated by the few community-based studies that have reported cases so far. This review of published and unpublished hospital and community studies concludes that: between 15,000 and 30,000 cases of maternal tetanus occur each year, with a predominance of postpartum or puerperal cases; the number of postabortal tetanus cases reported is as largely underestimated as the number of induced abortions; the case fatality ratio is on the average 75% in the absence of treatment; tetanus antitoxin and cleaning of the wounded portal on entry are key components of case management; and universal and adequate coverage of reproductive- aged women by tetanus toxoid is the most cost-effective way to eliminate this often neglected cause of maternal death. The extent to which political and financial resources are mobilized will determine whether or not 150,000 to 300,000 women will die of maternal tetanus during the 1990"s. (Author abstract)