Maternal Mortality - PDF

Maternal Mortality Dr. INAS FADHIL OLEIWI Family Physician  Objectives By the end of this lecture you should be able to: ❖ Define & classify maternal deaths. ❖ Discuses MMR and MMRate ❖ Enumerate factors effects maternal death. ❖ Enumerate Factors influencing the outcome of pregnancy....

Maternal Mortality Dr. INAS FADHIL OLEIWI Family Physician  Objectives By the end of this lecture you should be able to: ❖ Define & classify maternal deaths. ❖ Discuses MMR and MMRate ❖ Enumerate factors effects maternal death. ❖ Enumerate Factors influencing the outcome of pregnancy. ❖ Evaluate the time factor in providing emergency obstetric care and the key functions of EmOC. ❖ Identify the prevention of Maternal Deaths.  What Is Maternal Death? The death of a woman while she is pregnant or within 42 days of the termination of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. World Health Organization (WHO) WHO Estimates more than (500 000) Maternal Deaths Each Year MORE THAN ONE WOMAN DIE EVERY MINUTE from pregnancy-related causes  Maternal Death Direct deaths: resulting from obstetric complications of the pregnant state ( pregnancy, labor, and puerperium ) from intervention, incorrect treatment, or from a chain of events resulting from any of these. Indirect deaths: resulting from previous existing diseases, or disease that developed during pregnancy and which is not due to direct obstetric causes, but aggravated by the physiologic effects of pregnancy (exp. death from a cardiac lesion). Late deaths: occur between 42 days and one year after abortion, miscarriage, or delivery that are due to direct or indirect maternal causes. Coincidental deaths: from unrelated causes that happen to occur in pregnancy or in puerperium exp. car accidents.  DIRECT OBSTETRIC COMPLICATIONS Hemorrhage 21% Unsafe Abortion 14% Eclampsia 13% Obstructed Labor 8% Infection 8% Another cause 11% Account for 75% of Maternal Deaths  INDIRECT OBSTETRIC COMPLICATIONS Are Due to Pre-existing Conditions, including Malaria, Anemia and Hepatitis And Increasingly HIV / AIDS Account for 25% of Maternal Deaths  Maternal mortality ratio (MMR): The maternal mortality ratio (MMR) is defined as the number of (maternal deaths) during a given time period per 100,000 live births during the same time period. Maternal deaths: The annual number of female deaths from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 Maternal mortality ratio =(Number of maternal deaths / Number of live births) X 100,000 The MMR is used as a measure of the quality of a health care system.  Maternal mortality rate (MMRate): Maternal mortality rate: the number of maternal deaths (direct and indirect) in a given period per 100,000 women of reproductive age during the same time period. MMRate reflects the risk to women during pregnancy & childbirth women. it is influenced by : General socioeconomic condition Nutrition Sanitation Maternal health care  WHO Report 2014 Between 1990 and 2013, maternal mortality worldwide dropped by almost 50%. Millennium Development Goal 5 calls for an improvement in maternal health and reduction in maternal mortality by 75% by 2015,( from 1990 levels) WHERE DO WOMEN DIE TODAY? 99% of Maternal Deaths Today Occur in Africa, Asia, and Latin America  Why do women not get the care they need? Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. In high-income countries, virtually all women have at least 4 antenatal care visits, are attended by a skilled health worker during childbirth, and receive postpartum care. In low-income countries, just over a third of all pregnant women have the recommended 4 antenatal care visits.  Why do women not get the care they need? Factors that prevent women from receiving or seeking care during pregnancy and childbirth are: ❖poverty ❖distance ❖lack of information ❖inadequate services ❖cultural practices.  Factors reducing MMR Most of maternal deaths could be prevented if women have: Access to basic medical care during pregnancy , childbirth & postpartum period. Skilled attendance of birth. most maternal deaths occur either during or shortly after delivery High quality of postpartum care : health care immediately after a critical period of labor & delivery is a single most important intervention for preventing maternal mortality & newborn morbidity & mortality  Factors influencing outcome of pregnancy 1.Maternal factors : ▪Age, below 16 & above 40 ▪Parity: above 4 ▪Spacing: less than 2 years ▪Health status, body built especially height ▪Nutritional deficiency ▪Infection exp. syphilis, toxoplasmosis, rubella, CMV ▪Medical problems: D.M, hypertension, heart diseases, kidney disease. ▪smoking. 2. pregnancy-related factors: all risk factors associated with pregnancy & obstetric history.  Factors influencing outcome of pregnancy 3. Labor-related factors : ▪Mechanical factors: prolonged labor, malpresentation, disproportion, prolapse of cord, and trauma. ▪Chemical factors: analgesics & anesthetics given to pregnant women, or ketosis that may cause hypoxia, cerebral damage. ▪Neonatal infection: acquired from the birth canal of infected pregnant women during childbirth along the process of normal vaginal delivery. exp. HIV, ophthalmia moratorium  Factors influencing outcome of pregnancy 4. Fetal factors : that result from genetic ( inheritance problems) 5. Socioeconomic circumstances : may indirectly have an adverse effect on the outcome ▪low income & poor living conditions ▪Illiteracy or low education. ▪Faulty tradition. ▪Lack of medical care.  How Much Time Do We Have? If untreated, death occurs on average in 2 hours from Postpartum Hemorrhage 12 hours from Antepartum Hemorrhage 2 days from obstructed Labor 6 days from Infection Emergency Obstetric Care (EmOC) Key Functions 1. Antibiotics (IV or IM) 2. Oxytocic Drugs 3. Anticonvulsants 4. Manual Removal of Placenta 5. Removal of Retained Products 6. Assisted Vaginal Delivery 7. Surgery (Cesarean Section) 8. Blood Transfusion 1 to 8 ~ Comprehensive EmOC 1 to 6 ~ basic EmOC  Prevention of Maternal Deaths: ►Establishmaternal mortality committees - Improve standards of health facilities (hospitals and PHC centers) ► Proper training of health professionals (obstetricians, GPs, midwives, and TBAs) ► Community education to encourage mothers to- have ANC ► Identification and management of high risk - groups ► Research -