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 or pregnancy-aggravated causes, excluding accidental or incidental causes. This is according to the World Health Organization (WHO).
• Globally, over 500,000 maternal deaths occur yearly.
• The equivalent of more than one woman dying every minute from pregnancy-related causes.
• Maternal mortality is categorized into direct or indirect deaths.

Types of Maternal Deaths

• Direct Deaths: Result from obstetric complications during pregnancy, labor, or the puerperium (postpartum period). This includes incorrect treatment, complications from interventions, or a chain of events from any of those.
• Indirect Deaths: Result from existing or newly developed diseases during pregnancy that are worsened by the physiological changes of pregnancy. Cardiac conditions are an example.
• Late Deaths: Occur between 42 days and one year after the termination of a pregnancy (abortion, miscarriage, or delivery) due to direct or indirect maternal causes.
• Coincidental Deaths: Result from unrelated causes that occur during pregnancy or the postpartum period, such as car accidents.

Direct Obstetric Complications

• Hemorrhage (21%)
• Unsafe abortion (14%)
• Eclampsia (13%)
• Obstructed labor (8%)
• Infection (8%)
• Other causes (11%)
• Together these complications account for 75% of maternal deaths.

Indirect Obstetric Complications

• These account for 25% of maternal deaths.
• They result from pre-existing conditions, including malaria, anemia, hepatitis, and increasingly, HIV/AIDS.

Maternal Mortality Ratio (MMR)

• MMR is the number of maternal deaths during a time period per 100,000 live births during the same time period.
• Maternal deaths are the annual number of female deaths from any cause related to pregnancy or its management, excluding accidental or incidental causes, during pregnancy, childbirth, or within 42 days.
• The MMR is a measure of a healthcare system's quality.

Maternal Mortality Rate (MMRate)

• MMRate is the number of maternal deaths (direct and indirect) per 100,000 women of reproductive age in a given period.
• MMRate reflects the risk to women during pregnancy and childbirth.
• MMRate is influenced by general socioeconomic conditions, nutrition, sanitation, and maternal health care.

WHO Report 2014

• Between 1990 and 2013, worldwide maternal mortality decreased by nearly 50%.
• Millennium Development Goal 5 aimed to decrease maternal mortality by 75% by 2015 from 1990 levels.
• 99% of maternal deaths today occur in Africa, Asia, and Latin America.

Why Women Do Not Receive Needed Care

• Poor women in remote areas are least likely to receive adequate care, especially in regions with limited skilled healthcare workers (e.g., sub-Saharan Africa and South Asia).
• In high-income countries, almost all women receive at least 4 antenatal visits, skilled attendance during childbirth, and postpartum care.
• In low-income countries, less than a third of pregnant women receive the recommended four antenatal care visits.
• Factors preventing care include poverty, distance, lack of information, inadequate services, and cultural practices.

Factors Reducing MMR

• Access to basic medical care during pregnancy, childbirth, and the postpartum period.
• Skilled attendance during childbirth.
• High-quality postpartum care.

Factors Influencing Pregnancy Outcome

• Maternal Factors:
  • Age (under 16 or over 40)
  • Parity (number of pregnancies)
  • Spacing between pregnancies
  • Overall health
  • Nutritional status
  • Infections (e.g., syphilis, toxoplasmosis, rubella, CMV)
  • Pre-existing medical conditions (e.g., diabetes, hypertension, heart disease, kidney disease)
  • Smoking
• Pregnancy-related factors: All risks associated with pregnancy and obstetric history.
• Labor-related factors:
  • Prolonged labor
  • Malpresentation
  • Disproportion
  • Cord prolapse
  • Trauma
  • Chemical factors (analgesics, anesthetics, ketosis, leading to hypoxia, and cerebral damage).
  • Neonatal infection
• Fetal factors: Genetic factors
• Socioeconomic Circumstances: Low income, poor living conditions, low literacy, poor education, faulty tradition, lack of healthcare.

Emergency Obstetric Care (EmOC) Key Functions

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

Preventing Maternal Deaths

• Establishing maternal mortality committees in health facilities.
• Improving standards of hospitals and Primary Health Care centers.
• Proper training of healthcare professionals (obstetricians, GPs, midwives, and traditional birth attendants (TBAs).
• Community education to encourage mothers to receive antenatal care.
• Identifying and managing high-risk groups.
• Research.

Time Sensitivity of Treatment

• 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.

Test your understanding of maternal health, the factors influencing pregnancy outcomes, and the critical interventions needed to prevent maternal mortality. This quiz covers important definitions, statistics, and concepts relevant to emergency obstetric care.