A spotlight on obstetric anesthesia in the developing world: finally getting the attention it deserves.

T he population growth of the planet is almost entirely in the developing world and is accompanied by an unacceptably high number of maternal deaths. The World Health Organization Millennium Development Goal 5 to reduce maternal mortality by 75% between 1990 and 2015 provides a clear target; however, an effective strategy to deal with the ongoing epidemic of preventable maternal mortality, including direct anesthetic deaths, has yet to be implemented. 1 Both direct and indirect obstet-ric deaths remain excessively high such that Millennium Development Goal 5 will not be achieved. 1 Despite an overall 47% decrease in maternal deaths since 1990, 2 the actual number of maternal deaths remains unacceptably high at approximately 287,000 per year, mostly in low-and middle-income countries. 3 Current data show that countries with lower birth and maternal mortality rates have managed to achieve a greater percentage reduction in their maternal mortality than regions and countries with higher rates. Why discuss the maternal mortality rate in an editorial in an anesthesiology journal? The developing world warrants a light being shone on its obstetric anesthesia needs. Improving access to safe, emergency obstetric surgical services can potentially save a large proportion of the lives lost. Apart from hypertension, dominant causes of maternal death in the developing world are hemorrhage, sepsis, and uterine rupture. All can follow obstructed labor, 1,4 often a result of great difficulty in accessing adequate obstetric and surgical services. These women often present extremely late and in extremis. 2 The information reported in an article from the nonprofit humanitarian organization, Kybele, Inc. (Winston-Salem, NC), by Olufolabi et al. 5 in the current issue of Anesthesia & Analgesia is consistent with other commentators who have suggested that improving obstetric anesthesia standards, especially in the low-income countries, will contribute to improving the general care and outcomes of parturients. Efforts to improve obstetric services have included a focus on improving operating room functionality 8 and anesthesia skills. 4,9 For example, data from sub-Saharan Africa suggest that the immediate (within 72 hours) postcesarean maternal mortality is between 5 and 25 times higher than in the United Kingdom; 80% of these deaths occur on the postoperative ward. 4,10 These data identify an opportunity to reduce maternal mortality by improving anesthesia and postanesthesia care. Considering the magnitude of the preventable mortality in low-income countries, there is a relative paucity of literature on successful interventions to improve maternal anesthesia outcomes in these …