Maternal and Perinatal Mortality

Question 1

What is the 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

What is maternal morbidity?

Answer 2

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

Question 3

What percentage of cases of global maternal mortality are from less-developed countries?

Answer 3

> 99%

Question 4

What is a maternal mortality ratio?

Answer 4

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

Question 5

What is a maternal mortality rate?

Answer 5

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 6

What is a lifetime risk of maternal death?

Answer 6

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

Question 7

What is a proportionate mortality ratio?

Answer 7

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 8

What does a maternal mortality ratio tell us?

Answer 8

The risk associated with each pregnancy

Question 9

What does a maternal mortality rate tell us?

Answer 9

Takes into account not only the obstetric risk, but also the frequency with which women are exposed to that risk

Question 10

What does a lifetime risk of maternal death tell us?

Answer 10

Women’s chance of becoming as well as dying in pregnancy

Question 11

What are the 2 ways of measuring maternal deaths?

Answer 11

• Facility-based

* Population/community-based

Question 12

What methods come underling facility-based?

Answer 12

•Health information systems
•Registries
•Confidential Enquiries
•Maternal death review
•Audit
-Critical Incident audit
-Criterion Based Clinical Audit

Question 13

What methods come underling community-based?

Answer 13

•Notification by law
•Vital registration
•Census
•Surveys or surveillance
-Sisterhood method
-Verbal Autopsy

Question 14

What was the effect of carrying out confidential maternal death enquiries in the UK?

Answer 14

There was a sharp decline in maternal deaths once this was initiated

Question 15

What are the 3 categories of maternal death?

Answer 15

• Direct deaths
• Indirect deaths
• Late deaths

Question 16

What are direct maternal deaths?

Answer 16

• 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

Question 17

What are indirect maternal deaths?

Answer 17

• Associated with a disorder, the effect of which is exacerbated by pregnancy (13%)
• Eg: Malaria

Question 18

What are indirect maternal deaths?

Answer 18

• ≥42 days but within one year after end of pregnancy

Question 19

How has the rate of indirect maternal deaths changed over time?

Answer 19

Indirect deaths have stayed static and had in fact increased for a short time period

Question 20

What is the greatest cause of maternal deaths in the UK?

Answer 20

Cardiac disease

Question 21

What is the 3 Delays Model?

Answer 21

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

Question 22

What might cause a delay in seeking 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 cause a delay in reaching care?

Answer 23

• Geography: Mountains, islands, rivers

* Lack of transport

Question 24

What might cause a delay in receiving care?

Answer 24

• Supplies, personnel

* Poorly trained personnel with punitive attitude

Question 25

How can maternal mortality be prevented?

Answer 25

• Antenatal care
• Skilled attendant at birth
• Emergency obstetric care

Question 26

What is involved in antenatal care?

Answer 26

• 4 visits
• Monitoring weight
• Blood pressure
• Proteinuria
• Folic acid
• Malaria prophylaxis

Question 27

What might be involved in emergency obstetric care?

Answer 27

• 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

Question 28

What is the definition of a still birth?

Answer 28

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

Question 29

What is perinatal mortality?

Answer 29

Includes both stillbirth and neonatal mortality

Question 30

What percentage of still births are unexplained?

Answer 30

40%

Question 31

What comprises essential newborn care?

Answer 31

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