Maternal Health

Question 0

Global maternal health from 1980-2008

Answer 0

181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5– Hogan et al 2010 lancet

Reduction from 320 to 251 per 100k live births

Due to inequalities:
•1% maternal deaths occur in high-income countries
•MMR higher in rural area
•MMR higher among low educated mothers

Question 1

Define maternal mortality and morbidity

Nb data on mortality is from household surveys, census, population based studies,

Answer 1

Maternal mortality (nb cause is either direct or indirect)
•Death of a woman while pregnant or within 42 days of termination of the pregnancy.
•Any cause related or aggravated by the pregnancy (accidental and incidental causes excluded)
•Maternal mortality ratio (MMR): number of maternal deaths for 100,000 live births

Maternal morbidity
•Any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing (WHO Maternal morbidity working group)

Question 2

Yearly decline in maternal mortality

Answer 2

181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5– Hogan et al 2010 lancet

> -5.5% decline in Northern Africa
But over 1 per cent increase in s Africa–

Question 3

Geographical variation in distribution if causes of maternal deaths

Answer 3

Asia Africa = haemorrhage
Latin America and Caribbean = hypertensive disorders

Khan et al 2006 lancet

Question 4

Mdg5

Answer 4

Reduction of maternal mortality ratio by 3/4 between 1990 and 2005

China and North Africa made it
Not South Africa
based on 1990-2011 annual change
Lozano 2010 lancet**

Indicators
Mmr
Proportion births attended by skilled health personnel - 9.4% in Somalia in 2006
Adolescent birth rate - 209 in CAR in 2009
Contraceptive prevalence rate. 3.5% in South Sudan
Antenatal care coverage - 22% Somalia 2006
Unmet need for family planning - 47.7% Somoa

who, global health observatory

Question 5

Pregnancy related illnesses and their consequences

Answer 5

Filippi 2006, Lancet

Social economic physical psyChological consequences

Suicide anaemia poverty depression damaged pelvic structure stigmatisation

Question 6

3 delays that lead to mortality in maternal health

Answer 6

Seeking care
Reaching healthcare facility
- lack of access to: family planning, health care facilities, quality care st birth, safe abortion, education, economic resources, life options
receive adequate treatment

Emergency Obstetric Care
•Target population: pregnant, intra- and post-partum women
–Equipment
–Access care within few hours
•Recognition of complications (1 delay)
•Access (2 delay)
•Impact: no robust evidence

Question 7

Major causes of maternal mortality: actions

Answer 7

Nour 2008 reviews in o&g

24% severe bleeding - oxytocin and manual compression
Eclampsia 12% magnesium sulphate

Campbell et al 2006 evidence suggests prioritisation should be intrapartum period

Question 8

Strategies of reducing maternal mortality: health centre intrapartum care (HCIC)

Answer 8

•Target population: all intrapartum women
•Approach:
–Normality of birthing process
–Psychological wellbeing
–Positive birthing experience
•Treatment component:
–Basic emergency obstetric care
–Comprehensive emergency obstetric care
•Impact: strong evidence of reduced maternal mortality

OBSTACLES:
Distance
Costs
Cultural barriers

To combat this:

Home services
•Skilled attendance at home
–basic care, emergency first aid
–Pro: Remote areas, demand for home-based care
–Con: inefficient in terms of time and action in case of emergency
•Community health workers at home (support for mother and baby)
–Con: unable to provide essential care, if improved expensive as skilled attendance
•Relatives or traditional birth attendants at home
–Con: Training needed, if improved expensive as skilled attendance
•Impact: no evidence of reduced maternal mortality

Question 9

Models of safe motherhood care

1 home non professional (traditional birthing assistant)
2 home professional
3 basic obstetric facility and professional
4 comprehensive essential obf and professional

Answer 9

Model 1 (Brazil, 1984 mmr=120)
Women wwith complications referred to centre
Supported by teaching staff, uniformed, felt part of team

Model 2 (Malaysia, 1970-80, mmr=50)
Tba to midwife (formal programme now)
Drugs (oxytocin)
Referral sites to urban district hospitals
Expansion of free health services to ruRal population

Model 3 (Sri Lanka mmr= 30)
Free access to hc services 

Model 4
HIC - midwives in Sweden and uk, obstetricians in USA

Evidence is strongly in favour of midwives Campbell et al 2006