Maternal Mortality Overview

Maternal Mortality

• Maternal mortality is the death of a woman while pregnant or within 42 days of pregnancy termination, caused by or aggravated by pregnancy or its management, but not accidental or incidental causes. (WHO)
• WHO estimates more than 500,000 maternal deaths annually.
• More than one woman dies every minute from pregnancy-related causes.

Types of Maternal Deaths

• Direct deaths: Result from obstetric complications of pregnancy, labor, or puerperium (e.g. hemorrhage, unsafe abortion, eclampsia).
• Indirect deaths: Result from pre-existing diseases aggravated by pregnancy (e.g. cardiac lesion).
• Late deaths: Occur between 42 days and one year after abortion, miscarriage, or delivery, due to direct or indirect maternal causes.
• Coincidental deaths: Result from unrelated causes during pregnancy or puerperium (e.g. car accidents).

Direct Obstetric Complications

• Hemorrhage (21%)
• Unsafe Abortion (14%)
• Eclampsia (13%)
• Obstructed Labor (8%)
• Infection (8%)
• Other causes (11%)
• Account for 75% of maternal deaths.

Indirect Obstetric Complications

• Pre-existing conditions (e.g. malaria, anemia, hepatitis, HIV/AIDS)
• Account for 25% of maternal deaths.

Maternal Mortality Ratio (MMR)

• MMR is the number of maternal deaths during a given time period per 100,000 live births during the same period.
• MMR is a measure of healthcare system quality

Maternal Mortality Rate (MMRate)

• MMRate is the number of maternal deaths (direct and indirect) per 100,000 women of reproductive age during a given period.
• MMRate reflects the risk to women during pregnancy and childbirth.
• Factors influencing MMRate include socioeconomic conditions, nutrition, sanitation, and maternal healthcare.

WHO Report 2014

• Maternal mortality worldwide decreased by nearly 50% between 1990 and 2013
• The Millennium Development Goal 5 aimed for a 75% reduction in maternal mortality by 2015 compared to 1990 levels.
• 99% of maternal deaths currently occur in Africa, Asia, and Latin America.

Access to Care: Why Do Women Not Get Necessary Care?

• Poor women in remote areas are least likely to receive adequate care, particularly in regions with few skilled healthcare workers.
• High-income countries provide nearly all women with at least four antenatal care visits, skilled birth attendance, and postpartum care.
• In low-income countries, only a third of pregnant women have the recommended antenatal visits.

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 periods
• Skilled birth attendance
• High-quality postpartum care

Factors Influencing Pregnancy Outcome

• Maternal Factors:
  • Age (under 16 or over 40)
  • Parity (number of previous pregnancies)
  • Pregnancy spacing (less than 2 years)
  • Health status, body build, height
  • Nutritional deficiencies
  • 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 pregnancy and obstetric history.
• Labor-Related Factors:
  • Prolonged labor
  • Malpresentation, disproportion, prolapse of cord, trauma
  • Chemical factors (analgesics, anesthetics, hypoxia, cerebral damage)
  • Neonatal infections (acquired from infected birth canals)
• Fetal Factors: Genetic inheritance problems
• Socioeconomic Circumstances: low income, poor living conditions, illiteracy, faulty traditions, lack of medical care

Emergency Obstetric Care (EmOC) Key Functions

• Antibiotics (IV or IM)
• Oxytocic drugs
• Anticonvulsants
• Manual removal of placenta
• Removal of retained products
• Assisted vaginal delivery
• Surgery (Cesarean section)
• Blood transfusion
• Comprehensive (1-8) vs. basic (1-6) EmOC

Prevention of Maternal Deaths

• Establish maternal mortality committees to improve health facility standards.
• Proper training for healthcare professionals (obstetricians, GPs, midwives, TBAs).
• Educate communities to encourage mothers to attend antenatal care (ANC).
• Identify and manage high-risk groups.
• Conduct research.

This quiz covers the critical topic of maternal mortality, focusing on definitions, types, and direct obstetric complications. Participants will explore the statistics and factors contributing to maternal deaths globally. Understand the various categories of maternal deaths to enhance knowledge in maternal health.