Mortality

Question 0

What are the two types of causes of maternal mortality?

Answer 0

Direct causes - cause directly attributed to pregnancy eg abortion, eclampsia, haemorrhage

Indirect causes - resulting from previous existing disease of disease developed through pregnancy, not from direct obstetric causes but aggravated by pregnancy eg heart disease

Question 1

What is the definition of maternal mortality in the UK?

Answer 1

The death of a mother while pregnant or within 42 days of pregnancy ending from any cause related to or aggravated by the pregnancy or it’s management (excluding coincidental or incidental deaths). Given as deaths per 100,000 maternities (live births or still births 24+ wks).

Question 2

How are late maternal deaths defined?

Answer 2

Late deaths - between 42 days and 1 year after termination, miscarriage or delivery that are due to direct or indirect causes.

Question 3

What is the size of p the uterus comparable to at 6, 8, 10, 12, 20 and 36 weeks?

Answer 3

6 weeks - lemon
8 weeks - orange 
10 weeks - grapefruit
12 weeks - suprapubically 
20 weeks - umbilicus 
36 weeks - xiphisternum

Question 4

Causes of maternal mortality

Answer 4

In order of most common direct causes (cardiac disease commonest overall):

• genital sepsis
• pre-eclampsia
• VTE
• amniotic fluid embolism
• early pregnancy, mainly ectopic
• haemorrhage
• anaesthetic
• fatty liver

Question 5

Perinatal mortality definition

Answer 5

Number of stillbirths and deaths in the first week of life /1000 births.

Stillbirths only include fetuses > 24wks (or if born earlier showing signs of life and then dies)

Other countries use different criteria so difficult to compare.

In UK 7.6/1000 in 2009

Question 6

Factors affecting perinatal mortality

Answer 6

• small babies
• preterm babies
• regional variation
• lower socio-economic class
• teenage mothers
• first babies (primip)
• multiple births

Question 7

Reasons for declining perinatal mortality

Answer 7

• improvements in standard of living
• improved maternal health
• declining parity
• improvements in medical care
  
  • treating syphilis, clean delivery, vaccine
  • detection and termination of malformed fetuses
  • less vaginal breach delivery
  • detecting placenta praevia
  • prevention of rhesus incompatibility
  • preventing progression pre-term labour
  • better control of diabetes and monitoring of at risk pregnancies