Maternal Mortality

Maternal death

death of a woman while pregnant or within 42 days of termination of pregnancy

• NOT accidental or incidental causes (ex. car accident or suicide would not count)

Pregnancy related death

Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of cause

Maternal-mortality ratio

number of maternal deaths per 100,000 livebirths

In which two regions of the world is the lifetime risk of maternal death (probability that a 15-year-old girl will die from complications of pregnancy or childbirth over her lifetime) in the world?

Sub-Saharan Africa (1 in 36)

South Asia (1 in 200)

Which income group has the highest lifetime risk of maternal death

low income

Which two of the Millenium Development Goals is related to maternal health

• 4: reducing child mortality

• 5: increasing maternal health

Although there is an overall decrease in maternal mortality from 1990 to 2015, there is still one region of the world in which it is still quite high (even though it has been improving)

Sub-saharan Africa

Within a country, where would you see differences among difference populations?

• income (low vs high)

• geography (rural v urban)

• ethnic/race differences

in terms of percentage, how much do direct causes of maternal deaths?

75%

• 27% hemorrhage

• 14% HTN

• 11% Sepsis

• 10% other

• 8% Abortion

• 3% Embolism

Major complications that contribute to the 75% direct causes of maternal mortality include

• severe bleeding

• infections

• high blood pressure

• complication from delivery

• unsafe abortions

The three delays related to maternal mortality

1. decision to seek care

   1. unrecognized life threating illnesses

2. arrival to an appropriate medical care facility

   1. poor or no transportation

3. In receiving adequate care once a woman arrives to a medical facility

   1. inadequate facilities

Why do women not get the care they need? (5 risk factors)

• POVERTY

• Distance to facilities

• Lack of information

• Inadequate and poor quality services

• cultural beliefs and practices

Which group of mothers and their babies are more prone to complications?

adolescent

3 intrauterine fetal demise

1. Stillbirth

2. Fetal demise

3. Fetal death

Fetal death

lack of breathing, heart rate, or movement PRIOR TO BIRTH

Stillbirth

lack of breathing, heart rate, or movements AT BIRTH

What are some causes of stillbirth

• congenital

• infection

• fetal growth restriction or placental insuffiency

• other fetal conditions

• no stillbirth conditions id

causes of stillbirth that are association with maternal conditions

• abnormal labour or uterine rupture

• maternal HTN

• maternal infection (ex. malaria)

• chorioamnitis

• maternal DM

• antepartum hemorrhage

What are some interventions for maternal mortality

• family planning

• folic acid supplementation

• adequate prenatal care

• syphilis detection and treatment

• diabetes detection and treatment

• skilled personnel in attendance during labor and delivery

• induction of labor for pregnancy lasting more than 41 weeks

• prevention and treatment of Malaria (and other infections)

__% of all maternal deaths occur in low and lower middle-income countries

94

The main causes of maternal deaths are: (5) *summary q

• severe bleeding

• infections

• HTN during pregnancy

• complication from delivery

• unsafe abortion

What kind of care BEFORE, DURING, and AFTER childbirth can save the lives of women and newborns?

skilled care