Maternal and perinatal mortality

Question 1

Maternal mortality

Answer 1

• Death of woman during pregnancy or within 43 days of termination of pregnancy
• Irrespective of duration and site of pregnancy, cause or management
• Not related to accidental and incidental causes

Question 2

Maternal morbidity

Answer 2

• Sever complications occurring during pregnancy and delivery that does not result in death

Question 3

Maternal mortality ratio

Answer 3

• Maternal mortality ratio → no. maternal deaths during time/ 100000 live births
• Risk associated with each pregnancy (obstetric risk)

Question 4

Lifetime risk of maternal death

Answer 4

• Likelihood of maternal death during reproductive age, expressed as an odd
• Woman’s chance of becoming pregnancy and dying during pregnancy

Question 5

Proportionate mortality ratio

Answer 5

Maternal deaths proportionate to all female deaths of a reproductive age (15-49) in given period

Question 6

Methods of measuring maternal deaths

Answer 6

• Facility based
  
  • Health information systems
  • Registries
  • Confidential enquiries
  • Maternal death reviews
  • Audits
• Population/ community based
  
  • Notification
  • Vital registration
  • Census
  • Surveys/ surveillance

Question 7

Why do mothers die

Answer 7

• Direct deaths
  
  • Obstetric complications
  • E.g haemorrhage, sepsis, preeclampsia, obstructed labour, unsafe abortion
• Indirect
  
  • Associative disorder
  • Exacerbated by pregnancy
  • e.g malaria
• Late deaths
  
  • > 43 days but within one year after end of pregnancy

Question 8

Causes of maternal mortality in UK (highest to lowest)

Answer 8

• Cardiac disease
• Thrombosis/ thromboembolism
• Neurological
• Psychiatric
• Sepsis
• Haemorrhage
• Malignancies
• Pre-eclampsia
• Anaesthetics
• Amniotic fluid embolism

Question 9

3 delays model

Answer 9

• Delay in decision to seek care
  
  • Misunderstood complications
  • Acceptance of maternal death
  • Socio-cultural barriers to seek care
  • Low social status
• Delay in reaching care
  
  • Lack of transport
  • Geographic barrier
• Delay in receiving care
  
  • Lack of supplies and personnel
  • Inadequately trained personnel

Question 10

How can we prevent maternal mortality

Answer 10

• Ante-natal care (4 visits to monitor weight, BP, proteinuria, folic acid and malaria prophylaxis)
• Skilled attendants at birth
• Emergency obstetric care
  
  • Clean delivery
  • Active management of 3rd stage
  • Parenteral antibiotics/ oxytocin/ magnesium sulphate
  • Manuel removal of placenta/ products of conception
  • Blood transfusion
  • C-section/ operative delivery

Question 11

Types of gestational mortality

Answer 11

• Stillbirth → birth of dead baby after 2-/24/28 weeks of gestation
• Early neonatal death → death within first week of life
• Late neonatal death → death within first 28 days of life
  
  • Perinatal mortality → includes stillbirth and neonatal mortality
  • Infant mortality → death of infant within first year of life
  • Child mortality → death of child within 5 years of life

Question 12

Why do babies die

Answer 12

• Congenital abnormality
• Cord problems
• Fetal
• Infection
• Intrapartum
• Maternal
• Neonatal
• Placenta
• Termination

Question 13

Essential newborn care

Answer 13

• Ensure baby is breathing
• Beginning exclusive breast feeding
• Keeping baby warm
• Washing hands before touching baby