CEDAW/C/49/D/17/2008 management but not from accidental or incidental causes”. 19 The author notes that Brazil officially claims to use these official WHO classifications for maternal death, 20 but that they have been improperly applied to the case. 5.15 Upon Ms. da Silva Pimentel Teixeira’s initial presentation at the health centre on 11 November 2002, medical professionals should have diagnosed and treated her for intrauterine foetal death, based on her urgent symptoms. However, intrauterine foetal death was not diagnosed until 13 November 2002, at which point the treating doctor should have immediately induced delivery. Following delivery of the stillborn foetus much later that day, her symptoms became much worse. Despite the fact that such symptoms should have led to immediate treatment, she did not receive the necessary curettage surgery to remove placental remnants until the following day. Despite the obvious need for immediate treatment and her continually worsening condition, she was not transferred to the general hospital until 49 hour s after delivery. Her medical records were not transferred with her and the personnel at the general hospital were unaware that she had recently been pregnant. The failure to transfer her records and to inform medical personnel that she was pregnant constitutes gross negligence. This chain of events clearly demonstrates that Ms. da Silva Pimentel Teixeira’s death resulted from the series of negligent medical interventions following intrauterine foetal death. Her death was therefore caused by obstetric compl ications related to pregnancy and should be categorized as a direct obstetric death. 5.16 The author argues that the classification of Ms. da Silva Pimentel Teixeira’s death as non-maternal exemplifies the widespread underreporting and misclassification of maternal deaths in the State party. The State party faces recurring problems with respect to the official death certificates designed to document maternal deaths. The information on death certificates tends to be of poor quality or is simply incorrect. There are two specific informational problems related to death certificates, both of which are likely factors leading to Brazil’s misclassification of Ms. da Silva Pimentel Teixeira’s death as non -maternal. First, doctors commonly fail to record on the death certificate the fact that the patient was pregnant or had recently delivered, leading to the misclassification of many deaths as non-maternal. In Ms. da Silva Pimentel Teixeira’s case, there is no mention of pregnancy on the official death certificate. Second, doctors in Brazil often fail to relate the immediate or final cause of death to the patient’s pregnancy, further leading many deaths to be classified as non-maternal. The Ministry of Health has recognized the difficulties of monitoring maternal mortality when doctors do not relate deaths to the patient’s pregnancy. Physicians often declare the cause of death to be a “terminal complication”, or use other medical terms, such as “haemorrhage”, that are not specifically connected to pregnancy. Ms. da Silva Pimentel Teixeira’s pregnancy is not explicitly mentioned on her death certificate, and the phrase “digestive haemorrhage” does not link her pregnancy to her death. In fact, this cause of death statement is incomplete and insufficient according to both i nternational and Brazilian medical standards. The autopsy process did not meet basic medical standards in regard to its thoroughness and its determination of the cause of death. This brief description of the cause of death closely parallels Brazil’s common reporting problems, raising concerns about its reliability. Furthermore, there is scant __________________ 19 20 11-51699 WHO, Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA, and the World Bank, p. 4. Ministério da Saúde, Manual dos Comites de Mortalidade Materna (3rd ed., 2007), p. 12. 17