Maternal and Perinatal Mortality

Question 1

definition of 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

definition of maternal morbidity

Answer 2

severe health complications occurring in pregnancy and delivery not resulting in death

Question 3

define maternal mortality ratio

Answer 3

Number of maternal deaths during a given time period per 100,000 livebirths during same time period

Question 4

define maternal mortality rate

Answer 4

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

Question 5

define lifetime risk of maternal death

Answer 5

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

Question 6

define proportionate mortality ratio

Answer 6

Maternal deaths as proportion of all female deaths of those of reproductive age – usually defined as 15-49 years – in a given time period

Question 7

what does maternal mortality ratio mean?

Answer 7

risk associated with pregnancy

Question 8

what does maternal mortality rate mean?

Answer 8

obstetric risk + frequency with which women are exposed to that risk

Question 9

what is lifetime rsk of maternal death?

Answer 9

a measure of women’s risk of becoming pregnant as well as the risk of dying while pregnant

Question 10

methods for measuring maternal deaths: facility based

Answer 10

o Health information systems
o Registries
o Confidential enquiries
o Maternal death review
o Audit
§ Critical incident audit
§ Criterion based clinical audit

Question 11

methods for measuring maternal deaths: population/community based

Answer 11

o Notification by law
o Vital registration
o Census
o Surveys or surveillance
§ Sisterhood method – have you had a sister that died?
§ Verbal autopsy – what happened?

Question 12

what are direct maternal deaths and main causes?

Answer 12

o Those related to obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received
o Haemorrhage, sepsis, pre-eclampsia, obstruction and unsafe abortion

Question 13

what are indirect maternal deaths and main causes?

Answer 13

o Those associated with a disorder, the effect of which is exacerbated by pregnancy
o Could have died anyway

Question 14

what are late maternal deaths and main causes?

Answer 14

o Occur >42 days after end of pregnancy but within one year

o HIV

Question 15

name the 3 delays model and describe each one

Answer 15

1. Delay in decision to seek care
   a. Lack of understanding of complications
   b. Acceptance of maternal death
   c. Socio-cultural barriers to seeking care
   d. Low social status of women
2. Delay in reaching care
   a. Mountains, islands, rivers – poor organisation
3. Delay in receiving care
   a. Supplies, personnel
   b. Poorly trained personnel with punitive attitude
   c. Finances

Question 16

how can we prevent maternal mortality?

Answer 16

antenatal care
skilled attendant at birth
emergency obstetric care

Question 17

antenatal care requirements

Answer 17

4 visits, monitoring weight, BP, proteinuria, folic acid, malaria

Question 18

minimum skilled birth attendent

Answer 18

midwife

Question 19

minimum facilities needed for emergency obstetric care

Answer 19

a. Clean delivery
b. Active management of 3rd stage
c. Parenteral antibiotics/oxytocic’s/magnesium sulphate (pre-eclampsia)
d. Manual removal of placenta/products of conception
e. Comprehensive emergency obstetric care
Figure 4 When do Mothers Die?
Figure 3 Where do Mothers Die? Mostly Sub-Saharan Africa, Afghanistan, South Asia
i. Blood transfusion
ii. Caesarean section/operative delivery

Question 20

define stillbirth

Answer 20

Birth of a dead baby after 20/24/28 weeks (depending on the availability of neonatal care) of gestation weighing more than 500g

Question 21

define late neonatal death

Answer 21

withing first 28 days

Question 22

define early neonatal death

Answer 22

within first week

Question 23

define perinatal mortality

Answer 23

stillbirth + neonatal mortality

Question 24

define infant mortality

Answer 24

death within 1st year

Question 25

define child mortality

Answer 25

death within first 5 years

Question 26

define still birth rate

Answer 26

number of still births per 1000 births

Question 27

define neonatal mortality rate

Answer 27

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

Question 28

define infant morality rate

Answer 28

Number of deaths under 1 year per 1000 live births

Question 29

define child mortality rate

Answer 29

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

Question 30

what are the essential newborn care requirements

Answer 30

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

Question 31

describe the every newborn action plan

Answer 31

• Strengthen and invest in care during labour, delivery, 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