Maternal mortility rate in Pakistan is done in Pakistan with the collaboration of BRIC in different parts of Pakistan BY Attiqa and Noor

1. Maternal mortality in Pakistan
Introduction
In order to reduce the rate of pregnant’s women death over a worldwide, on eight
Millennium Development Goals (MDGs) in September of 2002, 189 worlds leader started work
together to attain aimed to decreases the mortality rate around 75% in between 1990-2015 but
it remains. In 2010 The International Classification of Diseases (ICD-10) explained maternal
death by reference of WHO as "rate of death of women during pregnancy or at the time of
delivery or after delivery within duration of 42 days, having direct or indirect origin but it not
belongs to incidental or accidental causes".[1] The WHO explained the source of maternal’s
death into two roots i.e., directly related or indirect related. Around 80% maternal death
happens due to directly related causes which may includes hemorrhage( uncontrolled
bleeding), sepsis, hypertensive disorders, prolonged or obstructed labor and unsafe abortion
while indirectly cause contained malaria, heart disease, hepatitis, anemia, and defects which
belongs to pre-existing medical conditions, due to these reason maternal death ratio lived
around 20%.[2] The hemorrhage in which blood loss occur during delivery, post partum, or
during labor, it being most serious condition in which 25% maternal death are reported. At the
time of delivery or during pregnancy bleeding may starts which is an alarm of any serious
condition.During pregnancy bleeding time, pain frquency, and bleeding quantity may or may not the
same all the time.[3] In pregnany's first trimester bleeding is very common which may be because of
ectopic pregnancy, miscarriage, placenta implantation in uterus, gestational trophoblast diseases,
infection, due to pregnancy changes in cervix cellunknown cause, placenta abruption or due to any
infection.[4] Sepsis being the second major risk because of it 15% maternal death happens
which occur due to unhygienic or pollutant environment or due to infection which transmitted
sexually, during pregnancy or unsterilized equipments used during delivery. Sepsisis life therating
condition occur because of response of our body against any infection as our immune system always
engaged to prevent us from infection or diseases but sometimes it's hyperactivity may leading an
infection. Usually sepsis form in the result of secretion of few chemicals into blood for fighting against
any infection regardless of its source leading to formation of edema or inflamation in whole body, but
sometimes sepsis may calls a medical emergency. High grade fever, high heart rate, increased breathing
rate are the most common symptoms of sepsis in pregnancy which may be occur due to pre-existing
pneumonia, blood infection, renal problems, or due to any abdominal condition.[5] Here we will discuss
about hypertensive disorder which is far most occuring condition noted during the duration of
pregnancy leading 12% maternal death ratio which on endorsement of National High Blood Pressure
Education Program Working Group on High Blood Pressure in pregnancy divided in four parts like in
chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension,
and gestational hypertension which are precised terminologies over pregnancy induce hypertension.[6]
Preeclampsia is characterized by high blood pressure, high protein content in urine ussualy occurs in
first time pregnancy or teen agers women or women of or above 40 years which may conatin some risk
factors likely women already have pre-existing preeclampsia, diabetes, rheumatoid arthritis, obesity.
Normally preeclampsia is asymptomimatic but sometimes it have some sign and symptoms except high
content of protein in urine, high blood pressure which are headache, reflex changes, abdominal ache,

2. low or no urine output, frequently increses body weight, nausea, dizziness, blurred vision.[7] Due to
obstructed or prolonged labor maternal death ratio is 8%. In obstructed pregnancy fetus extended
part is not moved through birth cancal and labor thought as obstruction inspitee of enough uterine
contraction beacuse birth canal is not straight and wide. Cephalo-pelvic disproportionwhich is
incongruous in between mother's pelvic brim and head of fetus is the most common cause of obstructed
pregnancy which occur due to malposition or malextension of fetus, malnutrited mother, fetus of
diabetic women. If this obstruction is neglected leading a high risk of maternal mortility ehich can be
subside by operation and remove this obstruction from mother.[8] During unsafe abortion globally 13%
or 67,000 cases per year maternal death occurs due to pregnancy termination done by untrained
practionier, or pregnancy termination in unhygene environment with non sterile equipment or due to
both condition. It links with long and short term morbidity too. Over a worldwide 8.5 million women
affected from unsafe abortion anually among them 3 million women doesnot recived any medical
treatment. Despite of strict laws and orders unsafe abortion is done every year. Improper
understanding, improper family planning being the burnning cause of unsafe obrtion.[9] In indirect
causes fwe discuss some burning sources in a followed manner. Malaria being the reason of low birth
weight neonants and maternal illness. Symptoms and problems because of mlaria during pregnancy is
varied depending upon geographical region, patient's immunity, and tranmission setting of plasmodium
falciparum which divided into two transmission setting high and low. In high transmission setting
p.falciparum pose infection which is asymptomatic usually in pregnancy which contribute in anemic
condition of maternal and placental parasitaemia ---transmission setting malaria occured in those
pregnant women who are on high chances of severe malaria, anemia which results in abortion, low birth
baby, premature baby, and in stillbirth.[10] In the duration of pregnancy increased heart rate, blood
volume leading increses in cardiac output in second trimester. Low vascular bed, gestational hormones,
prostaglandins in circulation in placenta may results in reduce peripheral vascular resistance and
ultimately in blood pressure. But during delivery uterine contraction and pain increases the cardiac
output and blood pressure leading maternal mortility chances.[11] In third trimester pregnant women
along with hepatitis E are highly exposed to some problems like acute renal failure, acute hepatic
failure,septicemia, antepaartum and postpartum hemorrhage, intravascular coagulation,preterm
delivery, multi organ failure, hypoglycemia,premature repture of membrane and death of a women. If
we especially talk about hepatitis E there is 20% mortality chances occur. These condition are developed
due to the transmission of virus in women.[12] Anemia usually occured due to lack of iron in diet as an
adult need iron 1.1mg/day and its twice needed by women in normal condition. But during pregnancy a
woman wants 1000mg of iron per day. But if nutrional profile of pregnant woman doesnot meet with it
leading the depletion of T-lymphocytes which involved in presenting of antigen to B-lymphocytes whcih
incolve in making antibodies against antigen and form memory cells.[13] But in Pakistan the major
cause of maternal mortility ratios (MMRs) is hemorrhage which followed sepsis and eclampsia
(accounts 78.1%). In report of MMRs which indicated that the ratio is not decreases in Pakistan
as sample is taken from three tertiary local hospital, one from north and two from south region.
But according to the words of Minino, et al, from US only 0.06% women died due to direct
related condition in world especially in well developed country. It can be overcome by
developing short , medium and long term strategies which also followed by deployment,
training and managements of well learned attendants in a big circle. Furthermore emergency
obstetric care availability is also required to improve above circumstances in health care
systems.[14]
Objective

3. To Screeningthe signsandsymptomsof maternal mortility.
To estimate the probable riskfactorsof maternal mortility.
Methodolgy
A descriptive cross-sectional study, had been held in Sheikhzaid Hospital larkana. A 384[15]
pregnant
female were examined in the obs and gyne unit. An informed consent will be obtained from each
participant. Medical history, demographic, and symptoms screening of every patient were done on a
surveybasedquestionnaire.
StudyParticipantRecruitment:
InclusionCriteria:
• Pregnantwomen
ExclusionCriteria:
• Nonpregnantwomen
• Alongwithanyspecificdisease
Data Management and Statistical Analysis
The data will be mined after coding for statistical analysis, monitoring and verification. The statistical
methods include analysis of data for the sample size selected, power of the study, level of significance,
procedures for accounting for any missing or spurious data etc. using SPSS as standard software. Data
collection team will gather data with the help of coordinators. The collected data will be kept safe at
BRIC office.
Limitations of Study
Disagreement of any collaborator for participation or unable to fulfill data sharing policy
requirements.
Refernces
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and Morbidity. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities.
NCBI;Third Edition(Volume 2).
2. Spotlights On Health and Rights. Causes of Maternal Mortality.
http://healthandrights.ccnmtl.columbia.edu/about.html.
3. Trop I and Levine D. Hemorrhage During Pregnancy Sonography and MR Imaging. American
Journal of Roentgenology.March2001; Volume 176: pages607-615.

4. 4. http://www.chop.edu/conditions-diseases/bleeding-pregnancyplacenta-previaplacental-
abruption.
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pages 1–5.
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Policy(EIP).WorldHealthOrganization.Geneva.July2003
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Medicine NationalsInstitueof Health.PUBMED. DEC 200; Volume 52( Issue 12): Pages539-44.
15. https://www.surveysystem.com/sscalc.htm