Introduction
 Maternal mortality ratio is widely used to provide a general sense of size of the problem of maternal deaths. However, it cannot be used to measure progress of maternal health programme on an annual basis and to compare geographic areas, because of its wide range of errors. This research estimates maternal mortality in six districts by using “unmet obstetric need” indicator in Tambacounda region, Senegal and describes possible application of the indicator to monitor, evaluate and facilitate maternal mortality reduction.
Methods
 We used data on caesarean sections performed in seven health facilities in Tambacounda and Kaolack regions in 2005, and calculated rates of the intervention for the residents of Tambacounda. We estimated maternal mortality ratios for selected severe obstetric complications in six districts by calculating the number of deficits for the caesarean sections for absolute maternal indications, which were the number of women who developed life-threatening events but could not receive the appropriate interventions for the diseases.
Results
 The rates of caesarean sections for all indications and for absolute maternal indications in the six districts ranged from 0.3 to 2.0% and from 0.1 to 0.9%, respectively. The estimated maternal mortality ratio for the absolute maternal indications in Tambacounda region was 651 (95%CI 554-761). Statistically significant differences in the ratios were observed between Koumpentoum district (maternal mortality ratio 966, 95%CI 741-1239) and Goudiry (877, 588-1260), and Kédougou (249, 119-457) and Bakel (296, 128-584).
Conclusions
 This study method enabled us to distinguish the difference in maternal mortality ratios for the selected severe obstetric complications between the small districts. It implies that the “unmet obstetric need” indicator can be used to compare geographic areas, to monitor trends, and to evaluate programme impact as well as baseline data to establish necessary measures to decrease maternal deaths.

The favorable effects of estrogen on cardiovascular diseases can be explained by several mechanisms such as changes in serum lipid profiles and thrombogenecity. Estrogen also affects the vascular tone, but there has been no report in which the effect of estrogen was tested comprehensively for several vasoactive substances, especially after long-term administration. Two weeks after bilateral ovariectomy in 8-week old female Sprague-Dawley rats, placebo or 17 beta-estradiol (E2) pellets (0.5 mg; released over 3 weeks) were implanted subcutaneously. Two weeks after pellet implantation, organ chamber experiments were performed using aortae. Compared with control, E2-treated vessels showed impaired endothelium-dependent relaxation to acetylcholine. E2 enhanced the contraction to norepinephrine and U46619 and had no effect on endothelin-1-induced contraction. In contrast, the contraction to angiotensin (AT)-II was inhibited by E2. Northern blot analysis for AT1 receptor expression using cultured aortic smooth muscle cells showed no difference between control and E2-treated cells, suggesting that AT1 receptor downregulation is not the likely mechanism. These results suggest that E2 affects the vascular tone variably according to vasoactive substances.
Animal ; Estradiol/pharmacology* ; Female ; In Vitro ; Ovariectomy* ; Rats ; Rats, Sprague-Dawley ; Vasoconstrictor Agents/pharmacology* ; Vasodilator Agents/pharmacology* ; Vasomotor System/drug effects*