9.12 Maternal Mortality

Question 1

Define maternal death

Answer 1

The International Classification of Diseases, Injuries and Causes of Death- 10th revision defines a maternal death as
“the death of a woman while pregnant or within 42 days within termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. But not by accidental or incidental causes.

Question 2

Define maternal mortality ratio

Answer 2

The number of maternal deaths per 100 000 live births

SA: 800 000 deaths per year

Question 3

Define late maternal deaths

Answer 3

Death after 42 days but within 12 months

Question 4

Define confidential injury into maternal deaths

Answer 4

A systematic multidisciplinary anonymous investigation of all or a representative sample of maternal deaths occurring at an area, region or national level which identifies the number, causes and avoidable or remediable factors associated with them

Question 5

Maternal death notification

Answer 5

• requires that all death that occur during pregnancy, labour and 42 days of delivery be reported.
• deaths are subdivided into direct, indirect and coincidental deaths. - Only direct and indirect deaths are used for statistical purposes.
• Coincidental deaths are included in the recording of maternal deaths in South Africa to identify the magnitude of “violence against women and suicide in pregnancy

Question 6

Define direct maternal deaths

Answer 6

Deaths resulting from the obstetric complications of the pregnancy state. From interventions, omissions or incorrect treatment.

Question 7

Define indirect maternal deaths

Answer 7

Deaths resulting from previously existing disease or disease that developed during pregnancy which were not due to direct obstetric causes, but which we due the physiological effects of pregnancy

Question 8

Define coincidental maternal deaths

Answer 8

Deaths from unrelated causes which happen to occur in pregnancy or puerperium

Question 9

Define unknown maternal deaths

Answer 9

Death related to pregnancy where the underlying cause was not identified

Question 10

Describe the methodology after a maternal death

Answer 10

• a maternal death notification form (MDNF) is completed
• sent to a Provincial Co-coordinator who informs the NCCEMD
• case number is sent to a Provincial Assessor team
• assessors must provide information on Primary, Final and Contributory causes of death and must also establish whether there was avoidable factors or missed opportunities or any other aspects of sub-standard care involved in the maternal death.
• The NCCEMD uses this data to compile to reports on Maternal deaths in South Africa.
• Detailed reports are released every 3 years.

Question 11

What is the tasks of NCCEMD

Answer 11

• To make recommendations based on the study of maternal deaths to the Minister of Department of Health.
• Such that the implementations of the recommendations will result in a decrease in maternal deaths.

Question 12

Terms of reference of NCCEMD

Answer 12

• Make recommendations based on analysis of the maternal deaths that were reported such that the implementations of the recommendations will result in a decrease in maternal deaths.
• Recommendations must be phrased in such a manner that their implementation can be measured.
• Play an advisory role to the department of Health on the implementation of recommendations and monitoring of progress.
• Reports will document progress on implementation of recommendations
• Recommendations should be within the resources of a country
• Recommendations are made to the National Minister of Health

Question 13

5 main causes of maternal death in RSA

Answer 13

• Non-pregnancy related infections (HIV)
• Complications of hypertension in pregnancy
• Obstetric Hemorrhage
• Non-pregnancy related diseases (pre-existing medical conditions, especially cardiac disease)
• Pregnancy related infections especially septic abortions or puerperal sepsis