Maternal and Perinatal mortality Flashcards
What is maternal mortality?
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?
Maternal morbidity: Severe health complications occurring in pregnancy and delivery not resulting in death
What percentage of maternal deaths occur in less developed countries?
> 99%
What percentage of maternal deaths are preventable?
> 80%
What is maternal mortality ratio?
Maternal mortality ratio: Number of maternal deaths during given time period per 100 000 livebirths during same time period
What is maternal mortality rate?
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
What is Lifetime risk of maternal death?
Lifetime risk of maternal death: Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds
What is Proportionate mortality ratio?
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 maternal mortality ratio tell us?
Maternal Mortality Ratio represents the risk associated with each pregnancy, i.e. the obstetric risk.
What does maternal mortality rate tell us?
Maternal Mortality Rate takes into account not only the obstetric risk, but also the frequency with which women are exposed to that risk.
What does Lifetime Risk of Maternal Death tell us?
Lifetime Risk of Maternal Death is a measure of women’s risk of becoming pregnant as well as the risk of dying while pregnant.
Facility based methods for measuring maternal deaths?
> Health information systems > Registries > Confidential Enquiries > Maternal death review > Audit: - Critical Incident audit - Criterion Based Clinical Audit
Population/community based methods for measuring maternal deaths?
> Notification by law > Vital registration > Census > Surveys or surveillance: - Sisterhood method - Verbal Autopsy
What is the rate for maternal mortality in the UK?
8.8 per 100,000
What are direct deaths in maternity?
Direct deaths are defined as those related to obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received (87%)
Eg: Haemorrhage, Sepsis, Preeclampsia, Obstructed labour or Unsafe Abortion
What are indirect deaths in maternity?
Indirect deaths are those associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
Eg Malaria
What are late deaths in maternity?
Late deaths occur ≥42 days after end of pregnancy but within one year
What are the most common causes of maternal death worldwide?
1) Haemorrhage - 20%
2) Indirect - 15%
3) Hypertensive disorders - 13%
4) Sepsis - 10%
5) Unsafe abortion - 9%
6) Unsafe abortion - 9%
What are the most common causes of maternal death UK?
1) Cardiac disease
2) Indirect
3) Thrombosis/ thromboembolism
4) Haemorrhage
5) Neurological
6) Psychiatric
7) Sepsis
8) Amniotic embolism
9) Malignancies
10) Early pregnancy deaths
11) Pre-eclampsia
12) Anaesthesia
Since 2003 what has happened to maternal mortality?
Overall maternal mortality has declined over time, indirect deaths have stayed static and had in fact increased for a short time period.
What does the 3 Delays Model indicate about maternal deaths?
> 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
> Delay in reaching care:
- Geographical: Mountains, islands, rivers
- Lack of transport
> Delay in receiving care:
- Supplies, personnel
- Poorly trained personnel with punitive attitude
Which parts of the world have highest rates of maternal deaths?
Less developed countries have the highest rates. In particular, Sub-Saharan Africa and South Asia
How can we prevent maternal mortality?
> Antenatal care
> Skilled attendant at birth
> Emergency Obstetric Care
The Integrated maternal, newborn, and child health packages
What is more common maternal deaths or perinatal deaths?
Perinatal deaths are far more common than maternal death even globally
When is Early neonatal death?
Death of a baby within the first week of life
When is late neonatal death?
Death of a baby within the first 28 days of life
When is infant mortality?
Death of an infant within the first year of life
When is child mortality?
Death of a child within the first 5 years of life
When is perinatal mortality?
Includes stillbirth and neonatal mortality
The latest MBRRACE report counted for how many still births?
3000 stillbirths out of 780,000
The latest MBRRACE report counted for how many neonatal deaths?
1337 neonatal deaths out of 780,000
From 2013 and 2016 what was the change in baby deaths according to the MBRRACE report?
> 300 fewer baby deaths overall between 2013 and 2016 – 200 of which are stillbirths and 100 neonatal deaths
> Improved survival for twin pregnancies
How many times more likely are children in Sub-Saharan Africa more likely to die before the age of 5 than children in developed regions?
More than 14 times more likely
Where are there is highest rates of perinatal deaths?
Sub-Saharan Africa and South Asia
Essential newborn 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
