maternal mortality and its causes and how to reduce maternal mortality
- 2. DEFINITION As per the Tenth Revision of the International Statistical Classification of Diseases (ICD-10), a maternal death is defined as death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the site and duration of pregnancy from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes. Deaths from abortion and ectopic pregnancy are included in it
- 3. MATERNAL MORTALITY RATIO 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.
- 4. MATERNAL MORTALITY RATE Maternal mortality rate is the number of maternal deaths per 100,000 women of reproductive age (15-45 years) and reflects the medical risk of pregnancy and level of fertility in a population.
- 5. CAUSES OF MATERNAL DEATH Causes of maternal death can be classified into 3 categories- Direct deaths Indirect deaths Incidental deaths A woman is most vulnerable during at the post partum period. About 50- 70 percent maternal deaths occur in the postpartum period of which 45 percent deaths occur in the first 24 hours after delivery and more than two third during the first week. Between 11-17 percent of maternal deaths occur during child birth.
- 6. DIRECT CAUSES Direct maternal deaths relate to deaths resulting from complications of pregnancy, labour or the puerperium due to interventions, omissions or incorrect treatments or from a chain of events resulting from any of the above. Amongst the leading causes of direct maternal deaths are haemorrhage, sepsis, pre-eclampsia and eclampsia, abortions and obstructed labour. Almost 66 percent of deaths are due to direct cause, most of which are largely preventable
- 7. Haemorrhage: The most common single preventable cause is haemorrhage. It is responsible for 25 to 50%/(average 37%) deaths. Atonic postpartum haemorrhage is the most important cause followed by antepartum haemorrhage, bleeding from abortions, rupture uterus and ectopic pregnancy. Sepsis: About 11% of maternal deaths are caused by sepsis like puerperal sepsis. Septic abortions are responsible for 8% of all maternal deaths. Pre-eclampsia and eclampsia: These account for almost 5% of all maternal deaths with most women being without prenatal care. Prolonged and obstructed labour: About 5 of women die as a result of prolonged, neglected and obstructed labour due to dehydration, exhaustion and infection. They may suffer from uterine rupture or septic or hemorrhagic shock.
- 8. The most common single preventable cause is haemorrhage. It is responsible for 25 to 50%/(average 37%) deaths. Atonic postpartum haemorrhage is the most important cause.
- 9. INDIRECT MATERNAL DEATHS Indirect maternal deaths include deaths resulting from previous existing diseases or diseases that developed during pregnancy but got worsened by physiological effects of pregnancy or stress of labour. They cause about 34% maternal deaths. It includes diseases like anemia, heart disease, hepatitis and tetanus.
- 10. Anaemia: It accounts for (12-15%) of all maternal deaths and is a contributory factor in many other deaths. The women may die during pregnancy or labour due to congestive cardiac failure. Hepatitis: Pregnant women are 7-10 times more likely to suffer from hepatic failure, coma, coagulation failure, postpartum haemorrhage and death. During an epidemic, hepatitis may account for 10 to 15% of all maternal deaths. In some parts of North India like Delhi, hepatitis especially Hepatitis E is the leading cause of maternal mortality due to hepatic coma. Heart disease: Heart disease accounts for 5% of all maternal deaths with rheumatic heart disease with a tight mitral stenosis being particularly vulnerable for mortality. Tetanus: About 1% maternal deaths result from tetanus. Routine administration of tetanus toxoid to all pregnant women as part of prenatal care has helped to protect many lives
- 11. haemorrhage 37% sepsis 11% unsafe abortions 8% hypertensive disorder 5% obstructed labour 5% other clinical causes 2% anaemia 13% other indirect causes 13% unclassified 6% INDIRECT CAUSES OF MATERNAL DEATHS haemorrhage sepsis unsafe abortions hypertensive disorder obstructed labour other clinical causes anaemia other indirect causes unclassified
- 12. INCIDENTAL MATERNAL DEATHS Incidental maternal deaths are those deaths which result from accidents, malignant neoplasms, etc. They are not counted in maternal mortality and are called non-maternal deaths.
- 13. OTHER FACTORS AFFECTING MATERNAL DEATHS WOMEN’S AGE- the optimal child bearing age is between 20 to 30 years. The further away from this range, the greater the risks of a woman dying from pregnancy and childbirth. SHORT BIRTH INTERNVAL-It is associated with increased risk of maternal mortality. HIGH PARITY- high parity contributes to maternal mortality
- 14. LATE MATERNAL DEATHS It is "the death of a woman from direct or indirect obstetric causes, after more than 42 days but less than one year after termination of pregnancy". Like maternal deaths, late maternal deaths also include both direct and indirect maternal/obstetric deaths. Maternal deaths and late maternal deaths are combined n the 11th revision of the ICD under the new grouping of “comprehensive maternal deaths”.
- 15. PREGNANCY RELATED DEATHS also known as death occurring during pregnancy, childbirth and puerperium: It is defined as The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death obstetric and non-obstetric)": this definition includes unintentional/accidental and incidental causes.
- 16. INTERVENTIONS TO PREVENT MATERNAL DEATHS Promotion of family planning services, delay in age of marriage and child birth Early registration of pregnancy and hospital follow ups Dietary supplementation and prophylaxis for anemia Presence of skilled attendants at delivery and provision for safe abortions Functional referral system to facilities that provide comprehensive obstetric care Integrated management of indirect causes of maternal mortality by different departments Good anaesthetic facility and blood banks Maternal mortality review meetings
- 17. Global Strategy for Women's. Children's and Adolescent's Health 2016-2030 launched in the year 2015 with a vision to have by the year 2030, a "world in which every woman, child and adolescent in every setting realize their rights to physical and mental health and well being, has social and economic opportunities and is able lo Participate fully in shaping prosperous and sustainable society". It seeks to end all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their environments, health and wellbeing transformed. The global strategy goals of SURVIVE ,THRIVE and TRANSFORM and the targets to be achieved by 2030
- 21. MMR in India