Objectifs. - Determiner le taux de mortalite maternelle durant la derniere decennie en Tunisie, en tant que revelateur de la qualite du suivi obstetrical et des mesures qui s'imposent.Patientes et methodes. - Etude retrospective effectuee au service de gynecologie-obstetrique de l'hopital militaire principal d'instruction de Tunis sur la mortalite maternelle durant les 11 dernieres annees (de 1990 a 2001), qui a permis de recenser dix cas de deces maternel.Resultats. - Le taux de mortalite maternelle etait de 33,72 pour 100 000 naissances vivantes. L'age moyen de nos patientes etait de 31,2 ans. La primiparite, la multiparite, les conditions socioeconomiques defavorables, la grossesse a risque et le mauvais suivi de la grossesse retrouves successivement dans 5, 1, 6, 3 cas constituent les principaux facteurs de risque de mortalite maternelle. Tous les deces etaient survenus apres l'accouchement dont 60 % dans le post-partum immediat (< 24 h). Les causes de deces etaient dominees par les causes directes (80 %) : l'hemorragie (40 %) ; la toxemie gravidique (20 %) ; les accidents anesthesiques (10 %) ; la steatose hepatique aigue gravidique (10 %) et l'infection (10 %). Les causes indirectes etaient retrouvees dans 20 % des cas.Discussion et conclusion. - Le deces a ete juge evitable dans 6 des cas, ce qui confirme, bien que la mortalite maternelle ait diminue ces dernieres annees, la necessite de poursuivre l'etude des facteurs de risque et des moyens d'y remedier.
Objectives. - To determine maternal mortality rate during the last decade as revealing the quality of obstetrical follow-up and the necessary measures to be taken.Patients and methods. - A retrospective study conducted in the department of gynaecology in the military hospital in Tunis between 1990 and 2001, permitted to count 10 cases of maternal death.Results. - Maternal mortality rate was about 33.72/100,000 live births. Mean age of patients was 31.2 years. Primiparity, multiparity, poor socio-economic conditions, high-risk pregnancies and bad follow-up were responsible in 5, 1, 6 and 3 cases and represent the risk factors of mortality. All deaths occurred after delivery, with 60% before 24 h. Causes of death were haemorrhage in 40%, gravidic hypertension in 20%, anesthetic accidents in 10%, acute hepatic failure in 10%, and infection in 10%. Indirect causes are responsible for 20% of cases.Discussion and conclusion. - Deaths were judged evitable in 66.6% of cases, which confirms, although maternal mortality has diminished in the recent past, the necessity of pursuing study of risk factors together with study of remedies to them.