Maternal and Perinatal Mortality Flashcards
What is maternal mortality?
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
What is maternal morbidity?
Severe health complications occurring in pregnancy and delivery not resulting in death
What events lead to maternal death?
- Normal pregnancy
- Complications
- Severe morbidity
- Near miss
- Death
What are the measure of maternal mortality?
- Maternal mortality ratio
- Maternal mortality rate
- Lifetime risk of maternal death
- Proportionate mortality ratio
Maternal mortality ratio
Number of maternal deaths during given time period per 100 000 livebirths during same time period
Maternal mortality rate
Number of maternal deaths in given time period per 100 000 women of reproductive age, or woman-years of risk exposure, in same time period
Lifetime risk of maternal death
Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds
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.
What does the maternal mortality ration represent?
The risk associated with each pregnancy i.e the obstetric risk
What does the maternal mortality rate take into account?
Not only the obstetric risk, but also the frequency with which women are exposed to that risk
What is the lifetime risk of maternal death a measure of?
Women’s risk of becoming pregnant as well as the risk of dying while pregnant
What facility based methods are there for measuring maternal death?
- Health information systems
- Registries
- Confidential Enquiries
- Maternal death review
- Audit (Critical Incident audit, Criterion based clinical audit)
What population/community based methods are there for measuring maternal death?
- Notification by law
- Vital registration
- Census
- Surveys or surveillance (Sisterhood method, Verbal autopsy)
Why do mothers die?
- Direct deaths
- Indirect deaths
- Late deaths
What are direct maternal deaths?
Those related to obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received (87%)
Eg: Haemorrhage, Sepsis (labour related), Preeclampsia, Obstructed labour or Unsafe Abortion
What are indirect maternal deaths?
Those associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
Eg Malaria
What are late maternal deaths?
Deaths which occur >42 days after the end of pregnancy but within one year
What are the main causes of maternal death worldwide?
- Unsafe abortion
- Other
- Indirect
- Hypertensive disorder
- Sepsis
- Obstructed labour
- Haemorrhage
What are the main causes of maternal death in the UK?
- Cardiac disease
- Other indirect
- VTE
- Haemorrhage
- Neurological
- Psychiatric
- Sepsis
- Amniotic fluid embolism
- Malignancies
- Early pregnancy deaths
- Pre-eclampsia
- Anaesthesia
What is the 3 delays model of maternal mortality?
- Delay in decision to seek care
- Delay in reaching care
- Delay in receiving care
What contributes to delay in decision to seek care?
- Lack of understanding of complications
- Acceptance of maternal death
- Socio-cultural barriers to seeking care
- Low social status of women
What contributes to delay in reaching care?
- Geographics: mountains, islands, rivers etc.
- Lack of transport
What contributes to delay in receiving care?
- Supplies, personnel
- Poorly trained personnel with punitive attitude
How can we prevent maternal mortality?
- Antenatal care (4 visits, monitoring weight, blood pressure and proteinuria, folic acid, malaria prophylaxis)
- Skilled attendant at birth
- Emergency obstetric care
What emergency obstetric care can help prevent maternal mortality?
- 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
Stillbirth
Birth of a dead baby after 24 weeks of gestation or weighing more than 500g
Early neonatal death
Death of a baby within the first week of life
Late neonatal death
Death of a baby within the first 28 days of life
Perinatal mortality
Includes stillbirth and neonatal mortality
Infant mortality
Death of an infant within the first year of life
Child mortality
Death of a child within the first 5 years of life
What are the causes of stillbirth?
- Maternal cause
- Infection
- Intrapartum
- Placental
- Congenital anomaly
- Termination
- Cord problem
- Foetal problem
- Other
Where are there high rates of perinatal mortality?
Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in developed regions.
What is essential new-born care?
- Ensuring that the baby is breathing
- Starting the newborn on exclusive breastfeeding right away
- Keeping the baby warm
- Washing hands before touching the baby
What policy is in place to reduce perinatal mortality?
Every New-Born Action Plan
