Maternal and Perinatal Mortality

Question 1

What is maternal mortality?

Answer 1

The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes

Question 2

What is maternal morbidity?

Answer 2

Severe health complications occurring in pregnancy and delivery not resulting in death

Question 3

What events lead to maternal death?

Answer 3

• Normal pregnancy
• Complications
• Severe morbidity
• Near miss
• Death

Question 4

What are the measure of maternal mortality?

Answer 4

• Maternal mortality ratio
• Maternal mortality rate
• Lifetime risk of maternal death
• Proportionate mortality ratio

Question 5

Maternal mortality ratio

Answer 5

Number of maternal deaths during given time period per 100 000 livebirths during same time period

Question 6

Maternal mortality rate

Answer 6

Number of maternal deaths in given time period per 100 000 women of reproductive age, or woman-years of risk exposure, in same time period

Question 7

Lifetime risk of maternal death

Answer 7

Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds

Question 8

Proportionate mortality ratio

Answer 8

Maternal deaths as proportion of all female deaths of those of reproductive age—usually defined as 15–49 years—in a given time period.

Question 9

What does the maternal mortality ration represent?

Answer 9

The risk associated with each pregnancy i.e the obstetric risk

Question 10

What does the maternal mortality rate take into account?

Answer 10

Not only the obstetric risk, but also the frequency with which women are exposed to that risk

Question 11

What is the lifetime risk of maternal death a measure of?

Answer 11

Women’s risk of becoming pregnant as well as the risk of dying while pregnant

Question 12

What facility based methods are there for measuring maternal death?

Answer 12

• Health information systems
• Registries
• Confidential Enquiries
• Maternal death review
• Audit (Critical Incident audit, Criterion based clinical audit)

Question 13

What population/community based methods are there for measuring maternal death?

Answer 13

• Notification by law
• Vital registration
• Census
• Surveys or surveillance (Sisterhood method, Verbal autopsy)

Question 14

Why do mothers die?

Answer 14

• Direct deaths
• Indirect deaths
• Late deaths

Question 15

What are direct maternal deaths?

Answer 15

Those related to obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received (87%)

Eg: Haemorrhage, Sepsis (labour related), Preeclampsia, Obstructed labour or Unsafe Abortion

Question 16

What are indirect maternal deaths?

Answer 16

Those associated with a disorder, the effect of which is exacerbated by pregnancy (13%)

Eg Malaria

Question 17

What are late maternal deaths?

Answer 17

Deaths which occur >42 days after the end of pregnancy but within one year

Question 18

What are the main causes of maternal death worldwide?

Answer 18

• Unsafe abortion
• Other
• Indirect
• Hypertensive disorder
• Sepsis
• Obstructed labour
• Haemorrhage

Question 19

What are the main causes of maternal death in the UK?

Answer 19

• Cardiac disease
• Other indirect
• VTE
• Haemorrhage
• Neurological
• Psychiatric
• Sepsis
• Amniotic fluid embolism
• Malignancies
• Early pregnancy deaths
• Pre-eclampsia
• Anaesthesia

Question 20

What is the 3 delays model of maternal mortality?

Answer 20

• Delay in decision to seek care
• Delay in reaching care
• Delay in receiving care

Question 21

What contributes to delay in decision to seek care?

Answer 21

• Lack of understanding of complications
• Acceptance of maternal death
• Socio-cultural barriers to seeking care
• Low social status of women

Question 22

What contributes to delay in reaching care?

Answer 22

• Geographics: mountains, islands, rivers etc.

- Lack of transport

Question 23

What contributes to delay in receiving care?

Answer 23

• Supplies, personnel

- Poorly trained personnel with punitive attitude

Question 24

How can we prevent maternal mortality?

Answer 24

• Antenatal care (4 visits, monitoring weight, blood pressure and proteinuria, folic acid, malaria prophylaxis)
• Skilled attendant at birth
• Emergency obstetric care

Question 25

What emergency obstetric care can help prevent maternal mortality?

Answer 25

• Clean delivery
• Active management of 3rd stage
• Parenteral antibiotics/ oxytocics/ magnesium sulphate
• Manual removal of placenta/ products of conception
• Blood transfusion
• Caesarean section / operative delivery

Question 26

Stillbirth

Answer 26

Birth of a dead baby after 24 weeks of gestation or weighing more than 500g

Question 27

Early neonatal death

Answer 27

Death of a baby within the first week of life

Question 28

Late neonatal death

Answer 28

Death of a baby within the first 28 days of life

Question 29

Perinatal mortality

Answer 29

Includes stillbirth and neonatal mortality

Question 30

Infant mortality

Answer 30

Death of an infant within the first year of life

Question 31

Child mortality

Answer 31

Death of a child within the first 5 years of life

Question 32

What are the causes of stillbirth?

Answer 32

• Maternal cause
• Infection
• Intrapartum
• Placental
• Congenital anomaly
• Termination
• Cord problem
• Foetal problem
• Other

Question 33

Where are there high rates of perinatal mortality?

Answer 33

Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in developed regions.

Question 34

What is essential new-born care?

Answer 34

• Ensuring that the baby is breathing
• Starting the newborn on exclusive breastfeeding right away
• Keeping the baby warm
• Washing hands before touching the baby

Question 35

What policy is in place to reduce perinatal mortality?

Answer 35

Every New-Born Action Plan