16 - Maternal & Perinatal Mortality

Question 1

Define maternal mortality?

Answer 1

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)

Question 2

define maternal morbidity?

Answer 2

Severe health complications occurring in pregnancy and delivery not resulting in death

Question 3

% of cases in developing countries and % which are preventable?

Answer 3

> 99% in developing countries,

> 80% preventable

Question 4

how many measurements are there for maternal mortality?

Answer 4

4

Question 5

define maternal mortality ratio?

Answer 5

Number of maternal deaths during a given time period per 100 000 livebirths during same time period

Question 6

define maternal mortality rate?

Answer 6

Number of maternal deaths in a given time period per 100 000 women of reproductive age, or woman-years of risk exposure, in same time period

Question 7

define lifetime risk of maternal death?

Answer 7

Probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds

Question 8

define proportionate mortality ratio?

Answer 8

Maternal deaths as proportion of all female deaths of those of reproductive age—usually defined as 15–49 years—in a given time period

Question 9

How to interpret maternal mortality ratio?

Answer 9

The risk associated with each pregnancy, i.e. the obstetric risk

Question 10

How to interpret maternal mortality rate?

Answer 10

Takes into account not only the obstetric risk, but also the frequency with which women are exposed to that risk

Question 11

How to interpret Lifetime Risk of Maternal Death?

Answer 11

Women’s chance of becoming pregnant as well as dying in pregnancy

Question 12

what are the 2 methods for measuring maternal deaths?

Answer 12

facility based

population/ community based

Question 13

describe 5 facility based methods for measuring maternal deaths?

Answer 13

Health information systems

Registries

Confidential Enquiries

Maternal death review
Audit

Question 14

describe 2 types of audits?

Answer 14

Critical Incident audit

Criterion Based Clinical Audit

Question 15

describe 4 population based methods for measuring maternal deaths?

Answer 15

Notification by law

Vital registration

Census

Surveys or surveillance

Question 16

describe 2 types of surveys/ surveillance techniques?

Answer 16

Sisterhood method

Verbal Autopsy

Question 17

3 types of death?

Answer 17

direct

indirect

late

Question 18

define direct death?

Answer 18

Obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received

Question 19

give 5 examples of direct death?

Answer 19

Haemorrhage

Sepsis

Preeclampsia

Obstructed labour

Unsafe Abortion

Question 20

define indirect death?

Answer 20

Associated with a disorder, the effect of which is exacerbated by pregnancy

Question 21

give an example of indirect death?

Answer 21

malaria

Question 22

define late death?

Answer 22

≥42 days but within one year after end of pregnancy

Question 23

What was the biggest cause of maternal deaths in UK?

Answer 23

cardiac disease

Question 24

In terms of ethnicity, rank these women from most at risk to least at risk -

White
Asian
Mixed ethnicity
Black

Answer 24

Black - x5

mixed ethnicity - x3

asian - x2

white

Question 25

in which 2 areas of the world are the majority of maternal deaths?

Answer 25

Sub-Saharan African regions

South Asia

Question 26

describe the 3 delays model?

Answer 26

1) Delay in decision to seek care
2) Delay in reaching care
3) Delay in recieving care

Question 27

give 2 examples of delay in decision to seek care?

Answer 27

Lack of understanding of complications

Socio-cultural barriers to seeking care

Question 28

give 2 examples of delay in reaching care?

Answer 28

geography - mountains, islands etc.

lack of transport

Question 29

give 2 examples of delay in recieving care?

Answer 29

supplies, personnel

poorly trained personnel with punitive attitudes

Question 30

3 ways in which we can prevent maternal mortality?

Answer 30

antenatal care

skilled attendant at birth

emergency obstetric care

Question 31

define stillbirth?

Answer 31

Birth of a dead baby after 20/ 24/ 28 weeks of gestation or weighing more than 500 g

Question 32

define early neonatal death?

Answer 32

Death of a baby within the first week of life

Question 33

define late neonatal death?

Answer 33

Death of a baby within the first 28 days of life

Question 34

define perinatal mortality?

Answer 34

Includes stillbirth and neonatal mortality

Question 35

define infant mortality?

Answer 35

Death of an infant within the first year of life

Question 36

define child mortality?

Answer 36

Death of a child within the first 5 years of life

Question 37

In terms of ethnicity, who is most at risk of neonatal mortality?

Answer 37

Black and Asian ethnicities have higher risk

Question 38

what is the most common cause of stillbirth?

Answer 38

unknown - most stillbirths are unexplained

Question 39

give 3 examples of reasons for stillbirth?

Answer 39

congenital anomaly

infection

issues with cord

Question 40

Give 4 things which make up the essential newborn care advice?

Answer 40

Ensuring that the baby is breathing

Starting exclusive breastfeeding right away

Keeping the baby warm

Washing hands before touching the baby