Family medicine

Maternal Mortality


Assistant Professor Dr. Batool A. Gh. Yassin Depart. Of Community & family Medicine Baghdad College of Medicine 2014

Objectives

By the end of this lecture you should be able to: Define & classify maternal deaths & disability. List the most common causes of maternal mortality. Value the time factor in providing emergency obstetrical care. Identify the important steps for reducing maternal death. Enumerate the key functions of emergency obstetric care.

What Is Maternal Death?

The death of a woman while she is pregnant
…From any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.World Health Organization (WHO) …or…within 42 days of the termination of the pregnancy…

WHO Estimates 515 000 Maternal Deaths Each Year

MORE THAN ONE WOMAN DIE EVERY MINUTE from pregnancy-related causes


Direct MD: Deaths resulting from obstetrical complications of the pregnancy, labour, or puerperium, and from interventions, omissions, incorrect treatment, or a chain of events resulting from the above. Indirect MD: Deaths resulting from previous existing disease or a disease that developed during pregnancy, labour or puerperium and aggravated by the maternal physiological adaptation to pregnancy.
Maternal Death; Definitions

What Is Maternal Disability?

Short- or Long-term Illness Caused by Obstetric Complications
The Most Serious Maternal Disability Is Fistula (An Abnormal Passage Between Vagina and Bladder or Rectum often caused by obstructed labor when it is not treated with Cesarean Section)

What Do Women Die Of?

They Die Of Obstetric Complications That Need Not Be Fatal

DIRECTOBSTETRIC COMPLICATIONS

Hemorrhage 21% Unsafe Abortion 14% Eclampsia 13% Obstructed Labor 8% Infection 8% Other 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

Most Obstetric Complications Occur Suddenly

If women do not receive medical treatment on time, they will probably suffer disability… Or Die
Without Warning

WHERE DO WOMEN DIE TODAY?

99% of Maternal Deaths Today Occur in Africa, Asia and Latin America

WHAT ABOUT THE REST OF THE WORLD?

Maternal Deaths Used to be Very High in Europe and the U.S. So was Infant Mortality.
In 1915, Maternal and Infant Mortality Rates Were As High in the U.S. As They Are in Africa Today

WHAT HAPPENED NEXT?

Better Living Conditions Reduced Infant Mortality in the U.S. by over 40% between 1915 and 1933

BUT MATERNAL MORTALITY

“The well known triad of fever, hemorrhage and toxemia predominated…” REMAINED THE SAME


…Until the late 1930s There was a “steep and sustained decline which has continued in most Western countries at much the same rate for over fifty years”

What Happened To Reduce Maternal Mortality In The West?

Effective treatment for obstetric complications was developed and used, e.g., antibiotics for infection, blood transfusions for hemorrhage

Most Obstetric Complications

Can Neither Be Predicted Nor Prevented… But If Women Receive Effective Treatment in Time,
…Almost All Can Be Saved

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

Prevention of Maternal Deaths:

Establish maternal mortality committees Improve standards of health facilities (hospitals and PHC centres) 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

To Avert Death and Disability… …We Need To EnsureThat Women have Access To… Emergency Obstetric Care
(EmOC)

How Can We Improve Access To EmOC?

By making sure health facilities provide services needed to save women’s lives. Eight key functions “signal” a facility’sability to provide EmOC

EmOC Key FunctionsCover These Services

Antibiotics (IV or IM) Oxytocic Drugs Anticonvulsants Manual Removal of Placenta
Removal of Retained Products Assisted Vaginal Delivery Surgery (Cesarean Section) Blood Transfusion
All these services should be provided at the Comprehensive EmOC level , whereas the first six services should be provided at the level of basic EmOC

THE GOOD NEWS

Not all these functions need hospitals and doctors
Well-trained nurses and midwives can perform most at Basic EmOC Facilities
An Important Point For Resource Poor Areas

How Can We Tell We Are Making a Difference?

If we know we have provided enough EmOC… …and if we know that these services are being used by women suffering obstetric complications… WE CAN BE CONFIDENT THAT WE ARE SAVING WOMEN’S LIVES

How Do We Know Which Women Will Experience Complications?

WE DON’T

…But we do know that of any population of pregnant women 15% will experience an obstetric complication …This is as true of pregnant women in the US and Europe as of women in Africa, Asia and Latin America Nobody Knows Why This Happens. It Is a Fact of Life


Any Country Can Avert Maternal Death And Disability If It Makes Good EmOC
Available And Accessible