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23 Cards in this Set
- Front
- Back
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What is maternal mortality |
The death of a woman while pregnant or within 42 days of termination of a pregnancy irrespective of duration or site of the pregnancy from causes related to or aggravated by the pregnancy or its management but not due to accidental causes |
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Key facts about maternal mortality |
Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. 99% of all maternal deaths occur in developing countries. Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. Skilled care before, during and after childbirth can save the lives of women and newborn babies. Between 1990 and 2015, maternal mortality worldwide dropped by about 44%. Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births. |
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Direct & indirect maternal death |
1. Direct maternal death:•Maternal death due to complications of pregnancy or its management ~Obstetric haemorrhage, eclampsia 2. Indirect maternal death: •Maternal death due to pre existing or newly acquired condition ~Cardiac disease, HIV, TB |
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Maternal mortality ratio and maternal mortality rate |
1. Maternal mortality ratio (MMR) •The total number of maternal deaths per 100000 live births within a given period •This is generally used to compare status of different institutions and societies 2. Maternal mortality rate ( MMRate) •The total number of maternal deaths per 1000 women of reproductive age in that population within a given period |
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Maternal near miss |
Maternal near miss : A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of a pregnancy. |
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Epidemiology of maternal mortality |
Maternal mortality is commoner among the developing countries. MMR will vary between different countries There are also regional variations within the same country. More than 90% of maternal mortality occurs in sub saharan Africa and AsiaNigeria: 894/100000 ( Range = 596 – 1180) USA: 9.1/100000 |
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Direct causes of maternal mortality |
Direct causes •Haemorrhage •Sepsis •Pre eclampsia / eclampsia •Obstructed labour •Unsafe abortion •Anaemia |
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Indirect causes of maternal mortality |
•Cardiac diseases •Tuberculosis •HIV •haemoglobinopathies |
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Type 1 delay model |
Type 1 delay: •Patient or her care giver needs to appreciate that a medical need exist before they can seek help •They may consider the issue to be spiritual and so waste valuable time in faith based houses •The husband may not be convinced of any medical need. He is the financier •Delay in decision making |
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Type 2 delay model |
•Delay with transporting the patient to the hospital •Irregular transport system •Difficult terrains within the community •Security gates in the community |
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Type 3 delay model |
Delay in instituting the right treatment in the hospital An institutional delay Lack of personnel Lack of skill Lack of equipment Power supply Bureaucracies within the public hospital like insisting on advance payment even in emergency situations |
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Type M delay |
•Mortal delay •Doctor administers inappropriate treatment and so wasting valuable time •This delays the commencement of the correct treatment and may worsen the situation •Example is a patient referred with ruptured ectopic pregnancy and a medical office manages her as a threatened abortion |
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Social implications of maternal mortality |
•Family is thrown into confusion •Majority of the babies will die within the first year of life •Devastation of the husband •Has to take care of domestic issues •May start another marriage with the socio-economic effects •Maternal mortality is specially painful because pregnancy is not a disease but a physiological function |
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Tools of measurement of maternal mortality |
•MMR •MMRate •Life time risk of maternal death |
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Benefits of measurement of maternal mortality |
Measurement of maternal death is beneficial •Helps in planning •Monitoring and evaluation •Priority setting |
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Difficulties in measuring maternal deaths |
There are difficulties with measuring maternal deaths •Most deaths are maternal deaths are not reported •Poor vital statistics •Pregnancy status may not have been known at the time of death •Most of the MMR available are hospital based which clearly underestimates maternal deaths |
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Methods for measuring maternal deaths |
•Civil registration system •Household survey •Sisterhood methods •Reproductive age mortality studies (RAMOS) •Verbal autopsy •Census |
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Prevention of maternal mortality (old & new approaches) |
•Different approaches in the past •The safe motherhood initiative ~Antenatal care ~Training of TBAs •Results were disappointing and so emphasis was shifted to providing skilled care •Political will •Female education to provide ~Female empowerment ~Economic emancipation ~Equity •Evidence based recommendation for reduction of maternal mortality ~Skill birth attendance ~Provision of Emergency Obstetric care |
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Levels of prevention of maternal mortality |
1. Basic need/Primodial:•Female education•girl-child nutrition •Discourage early marriage •Stop harmful traditional practices 2. Primary prevention •Family planning to prevent unwanted pregnancy 3. Secondary level •Access to antenatal care •Skilled birth attendant during delivery •Use of appropriate technology like partograph •Prompt referral 4. Tertiary level •Provision of Emergency Obstetric care (EmOC) •Use of appropriate technology like anti shock garment •Early and prompt referral |
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Perinatal death rate |
According to recommendations of the WHO the term «perinatal death rate» or death rate at deliveries was introduced into health statistics and public health services practice. The world assembly of public health services has defined perinatal period as the period which begins from the twenty second full week (154th day) of a pre-natal life of a fetus (at this time body weight is 500 g in norm) and finishes after 7 full days (168 hours) after a birth. Perinatal death rate includes three periods: •Antenatal (beginning with the 22nd week of pregnancy up to delivery); •Intranatal (the period of delivery); •Early neonatal (the first 168 hours of life of a child). |
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Formula for perinatal mortality rate |
Death rate of children in perinatal period is characterized by factor of perinatal mortality rate which is calculated as the relation of the sum of the number of born dead and the number of those who have died in the first 168 hours of life to the number of born alive and dead: Number of born dead + number of died at the first 168 hours of life/Number of born alive and dead × 1000 |
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Risk factors of perinatal death rates |
The analysis of perinatal death rates allows to estimate succession in work of obstetric and pediatric services. Late registering of pregnancy, rare visiting of antenatal clinic by the expectant mother, absence of qualitative, interested supervision over the health of the pregnant woman are risk factors of perinatal death rates. |
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Causes of perinatal mortality |
Main causes: The main causes of death are intrauterine and birth asphyxia, low birth weight, birth trauma, and intrauterine or neonatal infections. The various causes of perinatal mortality may be grouped as below: 1. Antenatal Causes: Maternal diseases - hypertension, cardiovascular diseases, diabetes, tuberculosis, anaemia, pelvic diseases, anatomical defects, toxemias of pregnancy; 2. Intranatal Causes: Birth injuries, asphyxia, prolonged effort time, obstetric complications; 3. Postnatal Causes: Prematurity, respiratory distress syndrome, respiratory and alimentary infections, congenital anomalies |
