Maternal mortality.pptx

MATERNAL MORTALITY DEFINITION • A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incid...

MATERNAL MORTALITY DEFINITION • A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes (ICD-10). • DIRECT MATERNAL DEATH: The death of the mother resulting from obstetric complications of pregnancy, labour, or the puerperium, and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors. eg death from bleeding following delivery • INDIRECT MATERNAL DEATH: A death not directly due to an obstetric cause, but as a result of previously existing disease, or a disease that developed during pregnancy, labour, or the puerperium, and which was aggravated by maternal physiological adaptation to pregnancy, e.g anaemia, malaria, TB and AIDS • MATERNAL MORTALITY RATIO (MMR): The total maternal deaths in a given period per 100, 000 live births within the same period. It depicts the risk of death per live births within the period. The use of live births because of lack of data on abortion or miscarriage and still birth. • MATERNAL MORTALITY RATE (MMRate): The total number of maternal deaths in a given period per total women of reproductive age (15-49 years) in the same period. It reflects the risk per births and also the general fertility rate in the population. MATERNAL MORBIDITY • It refers any physical or mental illness or disability directly related to pregnancy and/or child birth. • Acute maternal morbidities. • Postpartum maternal morbidities and disabilities. • Chronic morbidities. • LIFE TIME RISK OF MATERNAL DEATH: This is the probability of dying from a maternal cause during a woman’s reproductive lifespan. • Calculated by multiplying maternal mortality rate by the length of the reproductive period (usually, 35 years). MEDICAL CAUSES OF DEATH AND TREATMENT (WHO, 2011) • HAEMORRHAGE • Post partum hemorrhage • World’s leading cause of maternal mortality • 127,000 maternal deaths annually • May cause up to 50% percent of all maternal deaths in developing countries – • Medicines • Oxytocin: 10 IU in 1-ml ampoule • Sodium chloride: injectable solution 0.9% isotonic or Sodium lactate compound solution – injectable (Ringer’s lactate). • Severe Pre-eclampsia and Eclampsia – Major health problems in developing countries. • Every year, eclampsia is associated with an estimated 50 000 maternal deaths worldwide. – • Medicines • Calcium gluconate injection (for treatment of magnesium toxicity): 100 mg/ml in a 10ml ampoule • Magnesium sulfate: injection 500 mg/ml in a 2-ml ampoule, 500 mg/ml in a 10-ml ampoule. • Maternal sepsis – Infection can follow an abortion or childbirth and is a major cause of death. – Sepsis not related to unsafe abortion accounts for up to 15% of maternal deaths in developing countries. – Medicines • Ampicillin: powder for injection 500 mg; 1 g (as a sodium salt) in vial • Gentamicin: injection 10 mg; 40 mg /ml in a 2-ml vial • Metronidazole: injection 500 mg in a 100-ml vial • Misoprostol: tablet 200 μg. • Prolonged/obstructed labour; Obstructed labour, also known as labour dystocia, is when the baby does not exit the pelvis during childbirth due to being physically blocked, despite the uterus contracting normally. • Abortion:Most abortions done in the U.S. take place in the first 12 to 13 weeks of pregnancy. MISCELLANOUS • Sexually transmitted infections – Nearly a million people acquire a sexually transmitted infection, including HIV, every day. – The results of infection include acute symptoms, chronic infection, and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer, and the untimely deaths of infants and adults. – Medicines • Uncomplicated genital chlamydial infections: Azithromycin: capsule 250 mg; 500 mg or oral liquid 200 mg/5 ml • Gonococcal infection – uncomplicated anogenital infection: Cefixime: capsule 400 mg • Syphilis: Benzathine benzylpenicillin: powder for injection 900 mg benzylpenicillin in a 5-ml vial; 1.44 g benzylpenicillin in a 5-ml vial. THREE DELAYS MODEL • The model has three levels of delay: • The first delay is the elapsed time between the onset of a complication and the recognition of the need to transport the patient to a facility. • The second delay is the elapsed time between leaving the home and reaching the facility. • The third delay is the elapsed time from presentation at the facility to the provision of appropriate treatment. • Proposed by Deborah Maine and her colleagues as the key determinants of maternal mortality. THE FIRST DELAY: • Related to • The low status of women • Poor understanding of complications and risk factors in pregnancy and when to seek medical help • Previous poor experience of health care • Acceptance of maternal death • Financial implications. THE SECOND DELAY: • Reated to: • Distance to health centers and hospitals. • Availability of and cost of transportation. • Poor roads and infrastructure. • Geography e.g. mountainous terrain, rivers. • Type of transport and the quality of the roads • Performance of the referral system between facilities. THE THIRD DELAY: • Related to: • Quality of care, such as the number and training of staff members . • Availability of blood supplies and essential equipment • Poor facilities and lack of medical supplies (little to no antibiotic availability) • Poorly motivated medical staff • • Inadequate sanitation. THREE DELAYS MODEL-WEAKNESS • Doesn’t include the concept of primary prevention (avoid pregnancy) and sec. prevention (avoid complications once pregnant). • Ignores family planning, non-communicable chronic diseases, antenatal care, and postpartum care. • Implicitly, it also assumes that complications arise at home, where women intend to give birth, whereas increasing numbers of women deliver in facilities. • It does not consider the newly identified “fourth delay,” which arises when women are discharged unwell or chronically ill from facilities and die at home during the post pregnancy period or in the next pregnancy . SYSTEMS APPROACH TO ADDRESSING MATERNAL MORTALITY • 6 Building Blocks (Technical) – Governance, Human Resource, Financing, Medicines, Health Info, Service Delivery. (WHO) • Local leadership is the key to changing systems and innovating programs that lead to better health outcomes (ZFF, 2012) – Focused on Mayors and MHOs who decide to change the health system, through meaningful engagements and new arrangements with CONCLUSION Medical and social factors are important to be understood. • There is a technical solution that can be implemented medical response, strengthening the health system. • Leadership will ensure that more stakeholders gain ownership of the issue. No mother should die giving life.