Maternal & Perinatal Death

Question 1

Define Maternal Mortality

Answer 1

Death while pregnant or <42 days post-termination from any cause related to or aggravated by the pregnancy or its management irrespective of duration/location of pregnancy

Question 2

What is maternal morbidity?

Answer 2

Any severe health complication occuring in pregnancy/delivery but not resulting in death

Question 3

What are the different ways we measure maternal mortality?

Answer 3

Maternal Mortality Ratio
Maternal Mortality Rate
Lifetime Risk of Maternal Death
Proportionate Mortality Ratio

Question 4

What is the Maternal Mortality Ratio?

Answer 4

No. of deaths : 100,000 livebirths over the same period

Shows the obstetric risk

Question 5

Whats the maternal mortality rate?

Answer 5

The no. of maternal deaths per 100,000 women of childbearing age

combines obstetric risk with frequency of exposure to that risk

Question 6

Whats the Lifetime risk of maternal death?

Answer 6

Odds of maternal death during a womans repdocutive life

Combines obstetric risk with risk of getting pregnant

Question 7

What do we use Lifetime risk for?

Answer 7

Evaluating the effectiveness of Family planning interventions

Question 8

What is proportionate mortality ratio?

Answer 8

Materanl deaths as a proportion of all deaths for women of child-bearing age (15-49)

Question 9

What are the categories for maternal death?

Answer 9

Direct (87%) - Deaths related to obstetric complications or treatment

Indirect (13%) - Deaths related to a disorder exacerbated by pregnancy

Question 10

What are the main causes of direct maternal death?

Answer 10

• Haemorrhage
• Sepsis
• Pre-eclampsia
• Obstructed Labour
• Unsafe Abortion

Question 11

What are the main causes of indirect maternal death?

Answer 11

Diseases like Malaria worldwide but Cardiac disease in the UK.

Direct causes 87% of maternal deaths worldwide but indirect actually predominates in the UK

Question 12

There are also socio-cultural reasons mothers-to-be die, how do we categorise them?

Answer 12

The 3 delays model:
- Delay in seeking Care
- Delay in Reaching Care
- Delay in Receiving Care

Question 13

Why would there be a delay in seeking care?

Answer 13

• Lack of understanding
• Acceptance of maternal death
• Cultural resistance to care
• Low status of women

Question 14

What measures are important to reduce maternal death?

Answer 14

• Antenatal Care
• Skilled Attendant (midwife) at the birth
• Basic Emergency Obstetric Care, Comprehensive if possible

Question 15

Whats included in basic antenatal care?

Answer 15

4 visits to monitor:
- Weight
- BP & Proteinuria
- Folic Acid
- Malaria Prophylaxis

Cuts maternal death

Question 16

Whats included in basic Emergency Obstetric Care?

Answer 16

• Clean Delivery
• Active Management of 3rd stage
• Parenteral Abx, Oxytocin & MgSO4 as required
• Manual removal of placenta/products of conception

Question 17

What needs to be available to turn basic into Comprehensive Emergency Obstetric Care?

Answer 17

Blood Transfusions and C-section need to be available to be classed as comprehensive EBC

Question 18

What are the different terms for describing foetal/baby death based on time period?

Answer 18

• Stillbirth
• Early
  Neonatal death
• Late Neonatal Death
• Perinatal Mortality
• Infant Mortality
• Child Mortality

Question 19

Define Stillbirth?

Answer 19

Birth of a dead baby after 24wks or >500g

Split into antepartum and intrapartum

Question 20

Define Neonatal Death?

Answer 20

Early = During 1st wk of life
Late = During 1st 28days of life

Question 21

Define Perinatal Mortality?

Answer 21

Combination of stillbirths and neonatal deaths

Question 22

Define infant and child mortality?

Answer 22

Infant = Death during 1st year
Child = death during 1st 5 yrs

Question 23

How can be prevent baby deaths?

Answer 23

Essential Newborn Care:
- Ensure breathing
- Start on exclusive breastfeeding ASAP
- Keep Warm
- Wash hands prior to touching baby

On a global policy level we have the Every Newborn Action Plan (ENAP)