Maternal and Perinatal Mortality

Question 1

What was the number of global maternal deaths in 2013?

Answer 1

289,000

Question 2

What percentage of cases of maternal mortality and morbidity are in less developed countries?

Answer 2

> 99%

Question 3

What percentage of maternal mortality and morbidity is preventable?

Answer 3

> 80%

Question 4

What number of women experience severe maternal morbidity?

Answer 4

> 20 million

Question 5

How is maternal health a public health indicator?

Answer 5

Greatest gap is between rich and poor countries

Question 6

What problems of measurement is maternal health subject to?

Answer 6

Subject to technical and operational problems

• under-reporting
• mis-classification
• incomplete vital registration

Question 7

What is maternal mortality?

Answer 7

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

Question 8

What is maternal morbidity?

Answer 8

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

Question 9

What is the maternal mortality ratio?

Answer 9

Number of maternal deaths during a given time period per 100,000 live births during the same time period

Question 10

What is the maternal mortality rate?

Answer 10

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

Question 11

What is the lifetime risk of maternal death?

Answer 11

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

Question 12

What is the proportionate mortality ratio?

Answer 12

Maternal deaths as proportion of all female deaths of those of reproductive age - usually defined as 15-19 years - in a given time period

Question 13

What does maternal mortality ratio represent?

Answer 13

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

Question 14

What does maternal mortality ratio take into account?

Answer 14

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

Question 15

What are the facility based methods for measuring maternal deaths?

Answer 15

Health information systems 
Registries
Confidential enquiries 
Maternal death review 
Audit - critical incident audit, criterion based clinical audit

Question 16

What are the population/community base methods for measuring maternal deaths?

Answer 16

Notification by law
Vital registration
Census
Surveys or surveillance

Question 17

What are direct maternal deaths?

Answer 17

Defined as those related to obstetric complications during pregnancy, labour or puerperium or resulting from any treatment received

Question 18

What are indirect maternal deaths?

Answer 18

Those associated with a disorder, the effect of which is exacerbated by pregnancy

Question 19

What are late maternal deaths?

Answer 19

Occur 42 or more days after the end of the pregnancy but within 1 year

Question 20

What are some causes of maternal deaths?

Answer 20

Sepsis and other maternal infections 
Complications of unsafe abortion 
Haemorrhage 
Indirect causes 
Hypertensive disorders 
Obstructed labour 
Other maternal conditions 
Underlying causes e.g. malnutrition

Question 21

What are the components of the 3 delays model?

Answer 21

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

Question 22

What might result in delay in decision to seek care?

Answer 22

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

Question 23

What might result in delay in reaching care?

Answer 23

Mountains, islands, rivers - physical barriers, poor organisation

Question 24

What might result in delay in receiving care?

Answer 24

Supplies, personnel
Poorly trained personnel with punitive attitude
Finances

Question 25

How can we prevent maternal mortality?

Answer 25

``` Antenatal care - 4 visits - monitoring weight, BP and proteinuria - folic acid - malaria treatment/prevention Skilled attendant at birth Access to emergency obstetric care - clean delivery - active management of 3rd stage of labour - parenteral antibiotics/oxytocics/magnesium sulphate - manual removal of placenta/products of conception - blood transfusion - Caesarean section/operative delivery ```

Question 26

What is the sustainable development goal 3.1?

Answer 26

By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

Question 27

What is the sustainable development goal 5.2?

Answer 27

Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation

Question 28

What is the sustainable development goal 5.6?

Answer 28

Ensure universal access to sexual and reproductive health and reproductive rights

Question 29

Currently, what are the two key aspects of the continuum of maternal care?

Answer 29

Ensuring maternal health needs with a life cycle approach | Providing maternal health care at the household, community and institutional level

Question 30

Who should be present at every delivery?

Answer 30

A qualified health worker

Question 31

What are the priorities for achieving sustainable development goals related to maternal health?

Answer 31

Prioritise quality maternal health services that respond to the local specificities of need and meet emerging challenges Promote equity through universal coverage of quality maternal health services, including for the most vulnerable women Increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability Guarantee sustainable finances for maternal-perinatal health Accelerate progress through evidence, advocacy and accountability

Question 32

What is stillbirth?

Answer 32

Birth of a dead baby after 20/24/28 weeks of gestation or weighing more than 500 grams

Question 33

What is early neonatal death?

Answer 33

Death of a baby within the first week of life

Question 34

What is late neonatal death?

Answer 34

Death of a baby within the first 28 days of life

Question 35

What is perinatal mortality?

Answer 35

Includes stillbirth and neonatal mortality

Question 36

What is infant mortality?

Answer 36

Death of an infant within the first year of life

Question 37

What is child mortality?

Answer 37

Death of a child within the first 5 years of life

Question 38

What is the stillbirth rate?

Answer 38

Number of stillbirths per 1000 births

Question 39

What is the neonatal mortality rate?

Answer 39

Number of deaths within the first 28 days per 1000 live births

Question 40

What is the infant morality rate?

Answer 40

Number of deaths under 1 year per 1000 live births

Question 41

What is the under 5 mortality rate?

Answer 41

Number of deaths between birth and 5 years of age per 1000 live births

Question 42

How many children under the age of 5 died in 2015?

Answer 42

5.9 million

Question 43

Children in Sub-Saharan Africa are how many times more likely to die before the age of 5 than children in developed regions?

Answer 43

14 times more likely

Question 44

How can we prevent infant morality?

Answer 44

Antenatal care mitigated through healthcare providers Intranatal care mitigated through skilled attendance at delivery Postnatal care mitigated through healthcare providers and mothers/relatives Early identification of danger signs during intranatal care and postnatal care Targeted interventions for cyclicality of neonatal deaths in scarred families Behaviour change, communications and counselling

Question 45

What is essential new born care?

Answer 45

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

Question 46

What is MDG goal 4?

Answer 46

2/3rds reduction in child mortality by 2015

Question 47

Between 1990 and 2015, how many of the 195 countries met the MDG 4?

Answer 47

62 of the 195

Question 48

What is the SDG 3.2?

Answer 48

End preventable deaths of newborns and under 5 children by 2030 Target of under 5 mortality of 25 or less per 1000 live births by 2030

Question 49

What are the components of the early newborn action plan?

Answer 49

Strengthen and invest in care during labour, delivery and first week of life Improve quality of maternal and newborn care Reach every woman and newborn to reduce inequities Harness the power of parents, families and communities Count every newborn - measurement, programme tracking and accountability