maternal and perinatal mortality Flashcards
what is maternal mortality
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
what is maternal morbidity
severe health complications occuring in pregnancy and delivery not resulting in death
where is the majority of maternal mortality
> 99% cases in less developed countries
what % of maternal mortality cases are preventable
> 80%
maternal mortality and public health
maternal mortality is a public health indicator with the greatest gap between high income and low income countries
define maternal mortality ratio
number of maternal deaths during a given time period per 100 000 livebirths during same period
define maternal mortality rate
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
define lifetime risk of maternal death
probability of maternal death duing a woman’s reproductive life, usually expressed in terms of odds
define proportionate mortality ratio
Maternal deaths as proportion of all female deaths of those of reproductive age—usually defined as 15–49 years—in a given time period.
interpreting maternal mortality ratio
the risk associated with each pregnancy
interpreting maternal mortality rate
take into account not only obstetric risk but also the frequency with which women are exposed to that risk.
interpreting lifetime risk
Women’s chance of becoming pregnant as well as dying in pregnancy
methods for measuring maternal deaths - facility based
health information systems registries confidential enquiries maternal death review audit - critical incident audit, criterion based clinical audit
methods for measuring maternal deaths - population/community based
notification by law
vital registration
census
surveys or surveillance - sisterhood method, verbal autopsy
why do mothers die
direct deaths
indirect deaths
late deaths
direct maternal deaths
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
indirect maternal deaths
associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
e.g. malaria
late maternal deaths
≥42 days but within 1yr after end of pregnancy
most common cause of maternal mortality in UK
cardiac disease - indirect thrombosis and thromboembolism - direct neurological - indirect psychiatric - both sepsis, haemorrhage, early pregnancy deaths, malignancies, amniotic fluid embolism, pre-eclampsia, anaesthesiaw
which ethnic groups are most affected by maternal mortality
black
rapid increase in maternal mortality rate in mixed ethnic groups
causes of maternal deaths worldwide
haemorrhage - 9% sepsis - 10% hypertensive disorders - 13% obstructed labour - 9% unsafe abortion - 20% others - 24% indirect - 14%
where in the world do most maternal deaths occur
sub-sahran africa
south asia
3 delays model
delay in decision to seek care
delay in reaching care
delay in receiving care
delay in decision to seek care in time
lack of understanding of complications
acceptance of maternal death
socio-cultural barriers to seeking care
low social status of women
