Maternal Health and Mortality Quiz

Maternal Mortality

• Maternal mortality is the death of a woman while pregnant or within 42 days of pregnancy termination due to pregnancy-related causes, not accidental or incidental causes.
• Globally, over 500,000 maternal deaths occur annually.
• On average, a woman dies every minute from pregnancy-related causes.
• 75% of maternal deaths are due to direct obstetric complications.

Direct Obstetric Complications

• Hemorrhage accounts for 21%.
• Unsafe abortion accounts for 14%.
• Eclampsia accounts for 13%.
• Obstructed labor accounts for 8%.
• Infection accounts for 8%.
• Another cause accounts for 11%.

Indirect Obstetric Complications

• Indirect complications are 25% of maternal deaths.
• These are due to pre-existing conditions such as malaria, anemia, and hepatitis.
• HIV/AIDS is increasingly a factor.

Maternal Mortality Ratio (MMR)

• MMR is the number of maternal deaths per 100,000 live births in a given time period.
• Maternal deaths are the annual number of female deaths related or aggravated by pregnancy management, excluding accidents or other unrelated causes, during pregnancy and childbirth or within 42 days.
• MMR is used to gauge the quality of healthcare systems.

Maternal Mortality Rate (MMRate)

• MMRate is the number of maternal deaths (direct and indirect) per 100,000 women of reproductive age within a specific time period.
• It reflects the risk associated with pregnancy and childbirth.
• MMRate is affected by general socioeconomic conditions, nutrition, sanitation, and maternal healthcare.

WHO Report 2014

• Global maternal mortality dropped by almost 50% between 1990 and 2013.
• The Millennium Development Goal 5 aims to reduce maternal mortality by 75% by 2015 (compared to 1990 levels).
• 99% of maternal deaths occur in Africa, Asia, and Latin America.

Factors Affecting Access to Care

• Poor women in remote areas are least likely to receive adequate care.
• This is especially true in regions with low numbers of skilled healthcare professionals, for example, sub-Saharan Africa and South Asia.
• In high-income countries, nearly all women get at least four antenatal care visits.
• Low-income countries see significantly fewer women taking the recommended four antenatal appointments.

Factors Preventing Care Seeking

• Poverty
• Distance
• Lack of information
• Inadequate services
• Cultural practices

Factors Reducing MMR

• Access to basic medical care during pregnancy, childbirth, and postpartum.
• Skilled attendance during birth is crucial.
• High-quality postpartum care is essential. Immediate care after labor and delivery is very important in preventing mortality.

Factors Influencing Pregnancy Outcomes

Maternal Factors

• Age (under 16 or over 40)
• Parity (number of pregnancies)
• Spacing (interval between pregnancies)
• Health status, body type, especially height
• Nutritional deficiency
• Infections (e.g., syphilis, toxoplasmosis, rubella, CMV)
• Medical conditions (e.g., diabetes, hypertension, heart disease, kidney disease)
• Smoking

Pregnancy-related Factors

• All risk factors associated with the pregnancy and obstetric history

Labor-related Factors

• Prolonged labor
• Malpresentation (fetal position issues)
• Disproportion (differences in size between mother and baby)
• Cord prolapse
• Trauma
• Chemical factors such as analgesics, anesthetics, and ketosis (which can lead to hypoxia), cerebral damage
• Neonatal infection acquired from the birth canal

Fetal Factors

• Genetic issues

Socioeconomic Circumstances

• Low income and poor living conditions
• Low literacy/education
• Cultural traditions
• Limited access to medical care

Time Factors in Emergency Obstetric Care (EmOC)

• Untreated postpartum hemorrhage can lead to death within 2 hours.
• Untreated antepartum hemorrhage can lead to death within 12 hours.
• Untreated obstructed labor can lead to death within 2 days.
• Untreated infection can lead to death within 6 days.

Emergency Obstetric Care (EmOC) - Key Functions

• Antibiotics (intravenous or intramuscular)
• Oxytocic drugs
• Anticonvulsants
• Manual removal of the placenta
• Removal of retained products
• Assisted vaginal delivery
• Surgery (Caesarean section)
• Blood transfusion

Prevention of Maternal Deaths

• Establish maternal mortality committees (to improve health facility standards at hospitals and primary healthcare facilities)
• Proper training of healthcare professionals (obstetricians, GPs, midwives, and traditional birth attendants [TBAs])
• Community education to encourage women to attend antenatal care (ANC)
• Identify and manage high-risk groups
• Research

Test your knowledge on maternal mortality ratios, their causes, and the effects of socioeconomic conditions on maternal health care. This quiz explores key factors influencing maternal mortality and evaluates the progress made towards Millennium Development Goal 5. Assess your understanding of the challenges and interventions in maternal health.