Maternal and Perinatal Mortality

Question 1

what is maternal mortality?

Answer 1

death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes

Question 2

what is maternal morbidity?

Answer 2

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

Question 3

Measures of maternal mortality:

what is Maternal mortality ratio?

Answer 3

number of maternal deathd during given time period per 100 000 livebirths during the same time period – risk associate with each -pregnancy

Question 4

Measures of maternal mortality:

what is Maternal mortality rate?

Answer 4

number of maternal deaths in given time period per 100 000 women of reproductive age, or women-years of risk exposure, in same time period – takes into account not only the obstetric risk but also the frequency with which women are exposed to that risk

Question 5

Measures of maternal mortality:

what is Lifetime risk of maternal death?

Answer 5

probability of maternal death during a woman’s reproductive life, usually expressed in terms of odds – women’s chance of becoming pregnant as well as dying in pregnancy

Question 6

Measures of maternal mortality:

what is Proportionate mortality ratio?

Answer 6

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

Question 7

Methods for measuring maternal deaths can be of what 2 types?

Answer 7

facility based or population/community based

Question 8

what are some facility based methods of measuring maternal deaths?

Answer 8

Health information system

registries

Confidential enquiries

Maternal death review

Audit – critical incident audit and criterion based clinical audit

Question 9

what are some population/community based methods of measuring maternal deaths?

Answer 9

Notification by law

Vital registration

census

Surveys or surveillance – sisterhood method (asks if you had any sister who had died during pregnancy or childbirth) or verbal autopsy (for assigning cause of death by interviewing relatives and neighbours who were present at the time of death)

Question 10

Why do mothers die?

what 3 mays may a mother die?

Answer 10

direct death

indirect deather

late death

Question 11

how do mother die form direct deaths?

Answer 11

obstetric complications during pregnancy, labour or puerperium (6 weeks) or resulting from any treatment received (87%) e.g. haemorrhage, sepsis, preeclampsia, obstructed labour, or unsafe abortion

Question 12

how do mothers die form indirect deaths?

Answer 12

associated with a disorder, the effect of which is exacerbated by pregnancy (13%) e.g. malaria

Question 13

what is a late death?

Answer 13

>42 days but within one year after end of pregnancy

Question 14

what are the different causes of maternal deaths worldwide?

Answer 14

Question 15

Socio-cultural causes of maternal mortality: 3 delays model

what is the 3 delays model?

Answer 15

Delay in decision to seek care

Delay in reaching care

Delay in receiving care

Question 16

why may there be a Delay in decision to seek care?

Answer 16

lack of understanding of complications, acceptance of maternal death, socio-cultural barriers to seeking care, low social status of women

Question 17

why may there be a delay in reaching care?

Answer 17

geography (e.g. mountains islands, rivers), lack of transport

Question 18

why may there be a delay in receiving care?

Answer 18

supplies, personnel, poorly trained personnel with punitive attitude

Question 19

how can we prevent maternal mortality?

Answer 19

• Antenatal care – 4 visits, monitoring weight, blood pressure and proteinuria, folic acid, malaria prophylaxis
• Skilled attendant at birth
• Emergency obstetric care - Clean delivery, Active management of 3rd stage, Parenteral antibiotics/ oxytocics/ magnesium sulphate, Manual removal of placenta/ products of conception, Blood transfusion, Caesarean section / operative delivery

Question 20

what is a stillbirth?

Answer 20

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

Question 21

what is an earlyneonatal death?

Answer 21

death of a baby within the first week of life

Question 22

what is a late nepnatal death?

Answer 22

death of a baby within the first 28 days of life

Question 23

what is perinatal mortality?

Answer 23

includes stillbirth and neonatal mortality

Question 24

what is infant mortality

Answer 24

death of an infant within the first year of life

Question 25

what is child mortality?

Answer 25

death of a child within the first 5 years of life

Question 26

what is involved in essential newborn care?

Answer 26

• Ensuring that the baby is breathing
• Starting exclusive breastfeeding right away
• Keeping the baby warm
• Washing hands before touching the baby