Maternal Mortality: Global Health Crisis

Maternal Child Health Nursing Framework

• Focuses on at-risk, high-risk, and sick clients.

WHO Maternal Mortality Fact Sheet (2020)

• Worldwide, 287,000 women died from pregnancy or childbirth complications.
• Global maternal deaths equate to approximately 800 deaths per day, or one death every two minutes.
• 95% of maternal deaths occur in low and lower-middle-income countries, which indicates significant health disparities.
• Between 2000 and 2020, the global maternal mortality ratio (MMR) decreased by 34%, but this decline has plateaued.
• Direct maternal death causes include severe bleeding, infections, high blood pressure during pregnancy, complications from unsafe abortions, and obstructed labor.
• Access to quality prenatal care, skilled birth attendance, and postnatal support can prevent maternal deaths.
• Reducing barriers to healthcare access and improving health systems are crucial for lowering maternal mortality.

The Philippine Statistics Authority (PSA)

• The PSA provides maternal health insights in the Philippines, and highlights achievements and areas for improvement.
• The maternal mortality ratio has remained relatively low with approximately 200 maternal deaths per 100,000 live births.
• Two-thirds of births occur at home, and only 56% of mothers receive assistance from health professionals during delivery.
• 88% of Filipino infants are breastfed at some point, but early supplementation is common.
• Exclusive breastfeeding for the first six months is essential, as colostrum is rich in antibodies.
• In 2022, there were 2,008 maternal deaths in the Philippines.
• Statistics highlight the importance of continual efforts to improve maternal health, skilled birth attendance, and breastfeeding.

Nursing Role in Genetic Assessment and Counseling

• Nurses assess family history covering at least three generations.
• Document the include ages of both parents, any consanguinity, and ethnic backgrounds.
• Thorough physical assessments of both parents and any affected children should be done.
• Pay attention to facial features, limb anomalies.
• Collect samples like blood and amniotic fluid to identify potential genetic disorders.
• Individuals or couples with previous children affected by congenital disorders, close relatives with genetic disorders, or known carrier status.
• Genetic testing is recommended for those with a personal history of chromosomal disorders, consanguineous relationships, or advanced parental age.
• Nurses play a pivotal role in genetic assessment and counseling by gathering family medical histories to identify risks.
• Nurses support healthcare providers during physical examinations.
• The collection of blood and other samples for lab analysis is key.
• Nurses with specialized training can offer genetic counseling to individuals and families.

Diagnostic Testing Options

• Diagnostic testing options are both invasive and non-invasive.

Invasive Tests

• Preimplantation Diagnosis is for in vitro fertilization to test embryos before implantation.
• Chorionic Villi Sampling (CVS) is a biopsy of placental tissue between 10–12 weeks of gestation.
• Amniocentesis involves collecting amniotic fluid between 15-18 weeks for karyotyping.
• Percutaneous Umbilical Blood Sampling (PUBS) uses fetal blood sampling after 17 weeks to diagnose blood disorders and karyotype analysis.
• Fetoscopy involves direct visualization of the fetus using a small camera during the second or third trimester.

Non-Invasive Tests:

• Nuchal Translucency Screening includes an ultrasound assessment at 11–14 weeks, combined with maternal blood tests.
• Cell-Free DNA (cfDNA) Testing is a maternal blood test available from 11 weeks to screen for chromosomal abnormalities.
• Maternal Serum Alpha-Fetoprotein (MSAFP) is a blood test to screen for neural tube defects and other anomalies.
• Maternal Quadruple Marker Screen: Blood test between 15–20 weeks to assess the risk of Down syndrome, trisomy 18, and trisomy 13.
• Fetal Anatomy Ultrasound involves detailed ultrasound between 18–22 weeks to detect structural anomalies.
• Newborn Screening uses blood tests performed shortly after birth to detect metabolic and genetic disorders.

Common Chromosomal Disorders:

• Trisomy 13 (Patau Syndrome) is characterized by midline facial defects, heart anomalies, and extra digits.
• Trisomy 18 (Edwards Syndrome) features growth restriction, heart defects, and clenched fists.
• Trisomy 21 (Down Syndrome) presents intellectual disability, characteristic facial features, and an increased risk of certain medical conditions.
• Turner Syndrome (45,X) affects females, leading to short stature and infertility.
• Klinefelter Syndrome (47,XXY) affects males, often resulting in hypogonadism and infertility.
• Cri-du-Chat Syndrome (5p-) is characterized by a high-pitched cry, intellectual disability, and distinct facial features.
• Fragile X Syndrome is the most common inherited cause of intellectual disability, associated with a fragile site on the X chromosome.

Nursing Diagnoses Related to Genetic Disorders:

• Coping impairment is related to the continuation of a genetically affected pregnancy.
• Fear can be related to the outcomes of genetic screening tests.
• Grief can be related to the inheritance pattern of a family's genetic disorder.
• Knowledge deficiency can exist regarding the inheritance patterns of specific disorders.
• Readiness for education can surround the potential for genetic transmission of diseases.
• Altered sexual activity may occur due to fear of conceiving a child with a genetic disorder.