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

what facility based methods are there for measuring maternal death?

Answer 5

• health information systems
• registries
• confidential Enquiries
• maternal death review
• audit (critical incident audit, criterion based clinical audit)

Question 6

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

Answer 6

• notification by law
• vital registration
• census
• surveys or surveillance (Sisterhood method, Verbal autopsy)

Question 7

why do mothers die?

Answer 7

direct deaths: related to obstetric complications, labour or puerperium or treatment received (87%)
- haemorrhage, sepsis (labour related), preeclampsia, obstructed labour or unsafe abortion

indirect deaths: associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
- malaria

late deaths: deaths occur >42 days after end of pregnancy but within one year

Question 8

what are the main causes of maternal death worldwide?

Answer 8

• unsafe abortion
• other
• indirect
• hypertensive disorder
• sepsis
• obstructed labour
• haemorrhage

Question 9

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

Answer 9

Question 10

what is the 3 delays model of maternal mortality?

Answer 10

delay in decision to seek care

• lack of understanding of complications
• acceptance of maternal death
• socio-cultural barriers/ low social status

delay in reaching care

• geographics (mountains, islands, rivers etc)
• lack of transport

delay in receiving care

• supplies, personnel
• poorly trained personnel with punitive attitude

Question 11

How can we prevent maternal mortality?

Answer 11

antenatal care
- 4 visits: monitoring weight, blood pressure and proteinuria, folic acid, malaria prophylaxis

skilled attendant at birth

emergency obstetric care

• 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 12

what is stillbirth

Answer 12

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

Question 13

what is early neonatal death

Answer 13

death of a baby within the first week of life

Question 14

what is late neonatal death

Answer 14

death of a baby within the first 28 days of life

Question 15

what is perinatal mortality

Answer 15

includes stillbirth and neonatal mortality

Question 16

what is infant mortality

Answer 16

death of an infant within the first year of life

Question 17

what is child mortality

Answer 17

death of a child within the first 5 years of life

Question 18

what are the causes of stillbirth?

Answer 18

Question 19

what is essential new-born care?

Answer 19

• ensure baby is breathing
• start newborn on exclusive breastfeeding right away
• keep baby warm
• wash hands before touching the baby

Question 20

what policy is in place to reduce perinatal mortality?

Answer 20

Every New-Born Action Plan