Maternal and perinatal mortality

Question 1

Define what maternal mortailty is

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

Define what maternal morbidity is

Answer 2

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

Question 3

What are the useful measures of maternal mortality?

Answer 3

Maternal mortality ratio

Maternal mortality rate

Lifetime risk of maternal death

Proportionate mortality ratio

Question 4

What does the maternal mortality ratio measure?

Answer 4

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

It represents the risk associated with each pregnancy, i.e. the obstetric risk.

Question 5

What is the maternal mortality rate?

Answer 5

Number of maternal deaths in a given time period per 100 000 women of reproductive age, or woman-years of risk exposure, in same time period

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

Question 6

What is lifetime risk of maternal death?

Answer 6

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

This shows women’s chance of becoming pregnant as well as dying in pregnancy

Question 7

What is the 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 is maternal mortality in the UK?

Answer 8

9.2 per 100,000

(2015-2017)

Question 9

When measuring maternal mortality, we differentiate between direct and indirect maternal deaths

What does direct deaths mean?

Answer 9

Obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received

eg - Haemorrhage, Sepsis, Preeclampsia, Obstructed labour or Unsafe Abortion

87% of maternal deaths

Question 10

When measuring maternal mortality, we differentiate between direct and indirect maternal deaths

What does indirect deaths mean?

Answer 10

Deaths associated with a disorder, the effect of which is exacerbated by pregnancy

13% of maternal deaths

eg Malaria

Question 11

What is meant by ‘late deaths’?

Answer 11

≥42 days but within one year after end of pregnancy

Question 12

What are the main causes of maternal deaths worldwide?

Answer 12

Haemorrhage

Unsafe abortion

Sepsis

Hypertensive disorders

Obstructed labour

Indirect & others

Question 13

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

Answer 13

Cardiac disease

*an indirect cause of maternal deaths*

Question 14

Where do the most maternal deaths happen?

Answer 14

Sub-saharan Africa

South asia

Question 15

‘The 3 delays’ model was a model that theorises that maternal deaths occurred because of delays at 3 crucial stages

What are these stages and what causes fall under them?

Answer 15

1) 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

2) Delay in reaching care:

• Geography
• Lack of transport

3) Delay in receiving care:

• Supplies, personnel (numbers)
• poor training of personnel with punitive attitudes

Question 16

How do we prevent maternal mortality?

Answer 16

Antenatal care

​Skilled attendant at birth

Emergency obstetric care

Question 17

Define the following:

• Stillbirth
• Early neonatal death
• Late neonatal death
• Perinatal mortality
• Infant mortality
• Child mortality

Answer 17

Stillbirth​ - birth of a dead baby after 20/24/28 weeks of gestation or weighing more than 500 g

Early neonatal death - within 1st week

Late neonatal death - within 28 days

Perinatal mortality = Stillbirth + neonatal mortality

Infant mortality - within 1st year

Child mortality - within 5 years

Question 18

In the UK, what ethnicities of baby are at highest risk of neonatal mortality?

Answer 18

Black & asian

This is the same with maternal mortality

Question 19

What are the largest causes of stillbirths in the UK?

Answer 19

Intrapartum event

Infection

Congenital anomalies

Question 20

What essential care should babies receive after birth to reduce perinatal mortality?

Answer 20

Ensuring that the baby is breathing

Starting exclusive breastfeeding right away

Keeping the baby warm

Washing hands before touching the baby