Post Graduate Student, Department of Community Medicine

1. Dr.Praseeda.B.K

2.  Definition
 Scenario worldwide and India
 Statistical measures of maternal mortality
 Approaches to measure maternal mortality
 Causes in worldwide and India
 Preventive and social measures to reduce
maternal mortality

3. “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.”

4.  5,29,000 deaths / yr or 400/ 1 lakh live births
 1 death per minute
 1% in developed countries
 Range – 24 to 830 / 100,000 live births

5.  An Indian woman dies from
complications related to pregnancy
and childbirth. Every seven
minutes
 The maternal mortality ratio in
India stands at 174 per 100,000
live births.
(2015)

6. 2011 2012 2013 2014 2015
206 197 189 181 174

7.  SRS data shows that that so far only three states
 Kerala with an MMR of 66 per 100,000 live births
 Tamil Nadu with an MMR of 90 per 100,000 live births
 Maharashtra with an MMR of 87 per 100,000 live
births
—have been able to achieve the millennium
development goal.

9. Maternal mortality
Ratio
India Kerala
2010-12 178 66

10.  Maternal mortality ratio
 Maternal mortality rate
 Adult life time risk of maternal death
 The proportion of Maternal Death of Women
of Reproductive age (PM)

11.  This represents the risk associated with each
pregnancy.
 It is calculated as the number of maternal
deaths during a given year per 100,000 live
births during the same period.

12. - Number of maternal deaths in a given period
per 100,000 women of Reproductive age
group in the same time period..

13.  Number of maternal Deaths in a given time
period divided by total deaths among women
aged 15-49 years..

14. 1. Civil Registration System
- Routine registration of Birth & Death
- continuous registration of birth and
death
2. Household Survey

15. - interviewing a representative sample of
respondents about the survival of all their
adult sisters.

16. - Include 4 questions
- How many sisters have you ever had born to same
mother who ever reached the age 15 (or those who
ever married), including those who are now dead??
- How many sisters who reached the age 15 are alive
now?
- How many of your sisters are dead?
- How many of your sisters who are died during
pregnancy or during child birth or during the sixth
weeks after the end of pregnancy?

17.  Not applicable when
- TFR < 4 children per family
- Areas of significant migration
- During civil war

18. - Identifying and investigating the causes of
all deaths of women of reproductive age
group in a defined area.
- Use triangulation of different sources of data
on death of women of reproductive age group
coupled with record review and / or verbal
autopsy to identify maternal death.
- Best way to estimate MMR

19. 5. Verbal Autopsy
- used to assign cause of death
through interview with family or community
member..

20. 6. Census
- National Census with addition of a limited
number of questions.

21. - Representative, Re-Sampled, Routine Household
Interview Of Mortality with Medical Evaluation.
- enhanced form of Verbal autopsy.
- included in SRS from 2002 onwards.

22. - Random re-sampling of field work by an
independent team for maintaining.
- Field staff will collect major symptoms
narrative of events leading to death .
- Two independent trained physicial will examine
the report
- Disagreement should be referred to Senior
third physician who adjudicate and find CDC 10
code

23.  Maternal and peri-natal death enquiry and
response
 Thoroughly examine and respond to social,
biological & medical events that led to a
maternal & Perinatal death
 Inquiries are conducted of the death that
occur in a community over several months of
time in order to identify common factors that
can be acted up on to prevent further deaths.

24.  Conducted using a verbal autopsy interview
with the families of diseased persons.
 Useful in areas were many deaths occur
outside health facilities and for highlighting
relevant social factors and health care
seeking problems.

25. 25%
15%
12%8%
13%
8%
20%
severe bleeding
Infection
eclampsia
obstructed labour
Unsafe abortion
other direct causes
indirect causes
Indirect causes- Eg: Anemia, Malaria, Heart disease

26. 38%
11%5%5%
8%
34%
heakorrhaage
sepsis
Hypertensive
disorder
obstructed labour
abortion

30.  Medical causes
 Non obstetric causes
 Social causes

31.  Obstectric causes
- Toxaemias of pregnancy
- Haemorrhage
- Infection
- Obstructed labour
- Unsafe abortion

32.  Non obstetric causes
- Anaemia
- Associated diseases
e.g., cardiac, renal, hepatic metabolic and
infectious Malignancy Accidents

33.  Age at child birth
 Parity
 Too close pregnancies
 Family size
 Malnutrition
 Poverty
 Illiteracy
 Ignorance

34.  Prejudices
 Lack of maternity services
 Shortage of health manpower
 Delivery by untrained dais
 Poor environmental sanitation
 Poor communications and transport facilities
 Social customs.

35. 1. Early registration of pregnancy
2. At least three antenatal check-ups
3. Dietary supplementation, including correction
of anaemia
4. Prevention of infection and haemorrhage
during puerperium
5. Prevention of complications, e.g., eclampsia,
malpresentations. ruptured uterus

36. 6. Treatment of medical conditions Eg:
hypertension, diabetes, tuberculosis, etc.
7. Anti-malaria and tetanus prophylaxis Clean
delivery practice In India
8. Trained local dais and female health workers
9. Institutional deliveries for women with bad
obstetric history and risk factors

37. 10. Promotion of family planning - to control
the number of children to not more than two.
and spacing of births
12. Identification of every maternal death, and
searching for its cause.

38.  Confidential Maternal Death Audit started in
1990’s
 Format and methodology revised in 2010
 District level monitoring committee formed.
 All maternal death in Govt and Private sector are
audited
 Kerala Federation of Obstetrics and Gynecologist
published study report on maternal Death

39.  In 2012, the international arm of the UK
National Institute for Health and Care
Excellence (NICE) partnered with the
government of Kerala, the NRHM and KFOG to
work to improve the obstetric care in the
state through developing standards based on
evidence-based clinical guidelines

40.  These ten action points have been piloted in
eight hos- pitals (six public and two private)
in Kerala from April 2013.

41. 1. Active Management of Third Stage of Labour
2. PPH Prevention – 4th Stage Management
3. Management of Post-Partum Haemorrhage with Blood and Blood
Products
4. Obstetric Intensive Care
5. Placenta Praevia Accreta
6. Pre eclampsia
7. Anti-hypertensive Treatment
8. Severe Hypertension in pregnancy and in Immediate Postpartum
Period
9. HELLP ( Hemolysis, Elevated Liver enzyme, Low Platelet)
10. Eclampsia