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 or pregnancy

irrespective of duration and site of pregnancy

from any cause related to or aggravated by the pregnancy or its management

NOT from accidental or indidental causes

Question 2

what is maternal morbidity

Answer 2

severe health complications occuring in pregnancy and delivery not resulting in death

Question 3

where is the majority of maternal mortality

Answer 3

> 99% cases in less developed countries

Question 4

what % of maternal mortality cases are preventable

Answer 4

> 80%

Question 5

maternal mortality and public health

Answer 5

maternal mortality is a public health indicator with the greatest gap between high income and low income countries

Question 6

define maternal mortality ratio

Answer 6

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

Question 7

define maternal mortality rate

Answer 7

number of maternal deaths in a given time period per 100 000 women of reproductive age, or women-years of risk exposure, in samee time period

Question 8

define lifetime risk of maternal death

Answer 8

probability of maternal death duing a woman’s reproductive life, usually expressed in terms of odds

Question 9

define proportionate mortality ratio

Answer 9

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 10

interpreting maternal mortality ratio

Answer 10

the risk associated with each pregnancy

Question 11

interpreting maternal mortality rate

Answer 11

take into account not only obstetric risk but also the frequency with which women are exposed to that risk.

Question 12

interpreting lifetime risk

Answer 12

Women’s chance of becoming pregnant as well as dying in pregnancy

Question 13

methods for measuring maternal deaths - facility based

Answer 13

health information systems
registries
confidential enquiries
maternal death review
audit - critical incident audit, criterion based clinical audit

Question 14

methods for measuring maternal deaths - population/community based

Answer 14

notification by law
vital registration
census
surveys or surveillance - sisterhood method, verbal autopsy

Question 15

why do mothers die

Answer 15

direct deaths
indirect deaths
late deaths

Question 16

direct maternal deaths

Answer 16

obstetric complications during pregnancy, labour or puerperium (6wks) or resulting from any treatment recieved (87%)
e.g. haemorrhage, sepsis, pre-eclampsia, obstructed labour, unsafe abortion

Question 17

indirect maternal deaths

Answer 17

associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
e.g. malaria

Question 18

late maternal deaths

Answer 18

≥42 days but within 1yr after end of pregnancy

Question 19

most common cause of maternal mortality in UK

Answer 19

cardiac disease - indirect 
thrombosis and thromboembolism - direct 
neurological - indirect 
psychiatric - both 
sepsis, haemorrhage, early pregnancy deaths, malignancies, amniotic fluid embolism, pre-eclampsia, anaesthesiaw

Question 20

which ethnic groups are most affected by maternal mortality

Answer 20

black

rapid increase in maternal mortality rate in mixed ethnic groups

Question 21

causes of maternal deaths worldwide

Answer 21

haemorrhage - 9%
sepsis - 10%
hypertensive disorders - 13%
obstructed labour - 9%
unsafe abortion - 20%
others - 24%
indirect - 14%

Question 22

where in the world do most maternal deaths occur

Answer 22

sub-sahran africa

south asia

Question 23

3 delays model

Answer 23

delay in decision to seek care
delay in reaching care
delay in receiving care

Question 24

delay in decision to seek care in time

Answer 24

lack of understanding of complications
acceptance of maternal death
socio-cultural barriers to seeking care
low social status of women

Question 25

delay in reaching care

Answer 25

geography - mountains, islands, rivers

lack of transport

Question 26

delay in recieving care

Answer 26

supplies, personnel

poorly trained personnel with punitive attitudes

Question 27

how to prevent maternal mortality

Answer 27

pre-natal care
skilled attendant at birth
emergency obstetric care

Question 28

pre-natal care

Answer 28

4 visits

monitoring weight, BP, proteinuria, folic acid, malaria prophylaxis

Question 29

emergency obstetric care

Answer 29

clean delivery
active management of 3rd stage
parenteral abx/ocytocics/magnesium sulphate
manual removal of placenta/products of conception
blood transfusion
CS/operative delivery

Question 30

causes of maternal death in UK

Answer 30

coincidental malignancy - 23%
suicide - 17%
drug and alcohol/others - 14%
cardiac disease - 12%
other indirect deaths - 7%
neurology - 7%
indirect - malignancy - 7%
thrombosis and thromboembolism - 5%
coincidental - others - 4%
coincidental - homicide - 3%
indirect - sepsis - 2%
direct - malignancy - <1%
direct - haemorrhage/early pregnancy death/pregnancy related sepsis/eclampsia/pre-eclampsia - <1%

Question 31

define stillbirth

Answer 31

birth of a dead baby after 20/24/28 wks of gestation or weighing >500g

Question 32

define early neonatal death

Answer 32

death of a baby within the first wk of life

Question 33

define late neonatal death

Answer 33

death of a baby within first 28 days of life

Question 34

define perinatal mortality

Answer 34

includes stillbirth and neonatal mortality

Question 35

define infant mortality

Answer 35

death of an infant within first yr of life

Question 36

define child mortality

Answer 36

death of a child within first 5yrs of life

Question 37

describe the trend in stillbirths and neonatal mortality in the UK

Answer 37

gradual decline

Question 38

mortality rates and ethnic groups

Answer 38

mortality rates remain exceptionally high for babies of Black and Black British ethnicity; still birth rates are over 2x those for babies of White ethnicity and neonatal mortality rates are 45% higher

similar for babies of Asian/Asian British ethnicity - stillbirth and neonatal mortality rates are 65% higher

Question 39

why do babies die - main causes of stillbirths

Answer 39

missing - 10%
congenital anomaly - 7%
cord - 3%
fetal - 2%
infection -11%
intrapartum - 11%
maternal - 4%
neonatal - 8%
placenta - 8%
termination - 1%

Question 40

where do most perinatal deaths occur

Answer 40

sub-saharan Africa and other parts of Africa
South Asia

children in Sub-Saharan Africa >14x likely to die before the age of 5 than children in high resource settings

Question 41

essential newborn care

Answer 41

ensuring the baby is breathing
start exclusive breastfeeding right away
keeping the baby warm
washing hands before touching the baby

as part of the integrated maternal newborn and child health care package

Question 42

integrated maternal newborn and child health care - clinical care

Answer 42

reproductive - post-abortion care, TOP where legal, STI case management

childbirth - emergency obstetric care, skilled obstetric care and immediate newborn care and resus, PMTCT

emergency newborn and childcare - hospital care of newborn and childhood illness (incl HIV care), extra care of preterm babies incl kangaroo mother care, emergency care of sick newborns

Question 43

integrated maternal newborn and child health care - outpatient

Answer 43

reproductive - family planning, prevention and management of STIs and HIV, peri-conceptual folic acid

antenatal care - 4 visit focused package, IPTp and bednets for malaria, PMTCT

post-natal care - promotion of healthy behaviours, early detection and referral for illness, extra care of LBW babies, PMTCT for HIV

child health care - immunisations and nutrition, IPTi and bednets for malaria, care of children w/ HIV, 1st level assessment and care of childhood illness

Question 44

integrated maternal newborn and child health care - family/communitt

Answer 44

adolescent and pre-pregnancy nutrition, education, prevention of STIs and HIV

counselling and prep for newborn care, breastfeeding, birth and emergencies

where skilled care isn’t available, consider clean delivery and immediate newborn care (hygiene, warmth and early BF)

healthy home care - newborn care, nutrition, seeking appropriate preventative care, danger sign recognition and care-seeking for illness, oral rehydration salts to prevent diarrhoea, case management for pneumonia/malaria/neonatal sepsis