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
Normal pregnancy ⇒ complications ⇒ severe morbidity ⇒ near miss ⇒ death
What is maternal morbidity?
Severe health complications occurring in pregnancy and delivery not resulting in death
Name four measures of maternal mortality
- Maternal mortality ratio
- Maternal mortality rate
- Lifetime risk of maternal death
- Proportionate mortality ratio
Define Maternal Mortality Ratio as a measure of maternal mortality
Number of maternal deaths during given time period per 100 000 livebirths during same time period.
Represents the risk associated with each pregnancy, i.e. the obstetric risk.
Define Maternal Mortality Rate as a measure of maternal mortality
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.
Takes into account not only the obstetric risk, but also the frequency with which women are exposed to that risk.
Define Lifetime Risk of Maternal Death as a measure of maternal mortality
Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds.
It is a measure of women’s risk of becoming pregnant as well as the risk of dying while pregnant.
Define Proportionate Mortality Ratio as a measure of maternal mortality
Maternal deaths as proportion of all female deaths of those of reproductive age—usually defined as 15–49 years—in a given time period.
Name the two different types of methods of obtaining information to measure maternal deaths
Facility based and population/community based
Give examples of facility based information sources to measure maternal deaths
- Health information systems
- Registries
- Confidential Enquiries
- Maternal death review
- Audit
- Critical Incident audit
- Criterion Based Clinical Audit
Give examples of population/community based sources to measure maternal deaths
- Notification by law
- Vital registration
- Census
- Surveys or surveillance
- Sisterhood method
- Verbal Autopsy (assigning cause of death by interviewing witnesses present at time of death)
Name the three catergories of maternal death
- Direct deaths
- Indirect deaths
- Late deaths
Define Direct Deaths
Deaths 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
Define Indirect Deaths
Deaths associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
I.e. Malaria
Define Late Deaths
Occur ≥ 42 days after end of pregnancy but within one year
What are the causes of maternal deaths worldwide?
- Haemorrage (9%)
- Sepsis (10%)
- Hypertensive disorders (13%)
- Obstructed labour (9%)
- Unsafe abrtion (20%)
- Others (24%)
- Indirect causes (15%)
What is Thaddeus and Maine’s 3 delays model and name them?
They proposed that maternal deaths occurred because of delays at 3 crucial stages.
Identifies three groups of factors which may stop women and girls accessing the maternal health care they need
- Delay in decision to seek care
- Delay in reaching care
- Delay in recieving care
What reasons might a mother delay in going to seek care?
- Lack of understanding of complications
- Acceptance of maternal death
- Socio-cultural barriers to seeking care
- Lowsocial status of women
What reason might a mother delay in reaching care?
- Geographical: Mountains, islands, rivers
- Lack of transport
What reason might a mother delay in recieving care?
- Supplies, personnel
- Poorly trained personnel with punitive attitude
In what regions is maternal death most prevalent?
Sub-saharan Africa and South Asia
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
- 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
Define Stillbirth
Birth of a dead baby after 20/ 24/ 28 weeks of gestation or weighing more than 500 g
Define early neonatal death
Death of a baby within the first week of life
Define late neonatal death
Death of a baby within the first 28 days of life
