Role of nurse in midwifery and obstetrical care

1. MATERNAL
MORBIDITY AND
MORTALITYPRESENTED BY,
ABIYA MARY BIJU
3RD YEAR BSC(N)
YASHODA LAXMI COLLEGE OF NURSING

2. MATERNAL MORTALITY:
DEFINITION:
Maternal mortality is defined as the death of a woman
who is pregnant or within 42 days of termination of
pregnancy, irrespective of the site or duration of
pregnancy, from any cause related to or aggravated by the
pregnancy and its management.

3. Maternal death:
The death of a woman while pregnant or within
42 days of termination of pregnancy,
 Irrespective of the duration and site of pregnancy,
 From any cause related to or aggravated by the
pregnancy or its management,
 But not from accidental or incidental issues.

4. CLASSIFICATION
OF MATERNAL
DEATH

5. Classification :
 Direct
Deaths resulting from obstetric complications in pregnancy, labour and
puerperium.
Indirect
Deaths resulting from previous existing disease or disease that developed
during pregnancy and which was aggravated during pregnancy.
Fortuitous
Deaths from other causes not related to or influenced by pregnancy.

6. Direct obstetric deaths;
The deaths resulting from obstetric complications of the pregnant state
(pregnancy, labour and the puerperium), from interventions, omissions, or
incorrect treatment, or from a chain of events resulting from any of the
above are called direct obstetric deaths.
Indirect obstetrical deaths
Those resulting from previous existing disease or disease that developed
during pregnancy and that was not due to direct obstetric causes but
aggravated by the physiological effects of pregnancy.

7.  LATE MATERNAL DEATH
It is the death of a woman from direct or indirect obstetric causes,
more than 42 days but less than one year, after termination of
pregnancy.
 PREGNANCY RELATED DEATH
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.

8. MATERNAL MORTALITY
RATE FORMULA

10. CAUSES OF
MATERNAL
MORTALITY

14. OBSTETRICAL CAUSES
- Toxaemias of pregnancy
- Haemorrhage
- Infections
- Obstructed labour
- Unsafe abortions

15. Non obstetric causes
- Anaemia
- Associated diseases
e.g., cardiac, renal, hepatic, metabolic,
infectious malignancies and accidents.

16.  Social causes
- Age at child birth
- Parity
- Too close pregnancies
- Family size
- Malnutrition
- Poverty
- Illiteracy
- Ignorance

17. Contd…..
- Prejudices
- Lack of maternity services
- Shortage of health manpower
- Delivery by untrained dais
- Poor environmental sanitation
- Poor communications and transport facilities
- Social customs

18. PREVENTIVE AND
SOCIAL
MEASURES

19. 1. Early registration of pregnancy.
2. Atleast three antenatal check-ups.
3. Dietary supplementation, including correction of anemia.
4. Prevention of infection and haemorrhage during
puerperium.
5. Prevention of complications, e.g., eclampsia,
malpresentations, ruptured uterus etc.
6. Treatment for medical conditions - e.g., hypertension,
diabetes, tuberculosis, etc.
7. Prophylaxis.

20. Contd…
8. Trained local dais and female health workers.
9. Institutional deliveries for women with bad
obstetrical history and risk factors.
10. Promotion of family planning – to control the
number of children to not more than two and
spacing of births.
11. Identification of every maternal death and
searching for its cause.

21. PERINATAL MORTALITY
AND
MORBIDITY RATES

22. PERINATAL MORBIDITY
 Perinatal morbidity and mortality are primarily the result
of poor placental perfusion or preterm delivery.
 Perinatal morbidity implies to the illness of the neonate
from birth to first four weeks of life.
 It results mainly due to birth trauma, asphyxia,
prematurity and congenital malformations.

23. PERINATAL MORTALITY
 Perinatal mortality ratio:
Fetal and early neonatal deaths x 1000
total live birth
- The World Health Organization defines perinatal mortality as the "number
of stillbirths and deaths in the first week of life per 1,000 total births, that 22
completed weeks (154 days) of gestation, and ends seven completed days
after birth“.

24. ROLE OF NURSE
IN MIDWIFERY AND
OBSTETRICAL CARE

25. ANTENATAL PERIOD
 Health history, obstetrical history and physical examination.
 Antenatal visits are done by a midwife.
 Abdominal examination and record is kept for further visits.
 Educating mothers.
 Identification of high risk mothers and referral services.
 Training of students at different levels, and supervision of co-
workers.

26. INTRANATAL PERIOD
Observing the mother.
Abdominal and vaginal examination.
Maintaining partograph.
Psychological support and supportive care.
Delivery of child.

27. POSTNATAL PERIOD
 Postpartum supervision and care.
 To detect any health problems of the mother and baby.
 Encourage breastfeeding.
 Measures to prevent any complications.
 Family planning instructions.
 Health education to mother .

28. THANK
YOU