Maternal mortality

2. DEFINITION
 As per the Tenth Revision of the International Statistical Classification of
Diseases (ICD-10), a maternal death is defined as death of a woman while
pregnant or within 42 days of termination of pregnancy irrespective of the
site and duration of pregnancy from any cause related to or aggravated by
pregnancy or its management but not from accidental or incidental causes.
Deaths from abortion and ectopic pregnancy are included in it

3. MATERNAL MORTALITY RATIO
The maternal mortality ratio (MMR) is defined as the number of maternal deaths
during a given time period per 100,000 live births during the same time
period.

4. MATERNAL MORTALITY RATE
 Maternal mortality rate is the number of maternal deaths per 100,000
women of reproductive age (15-45 years) and reflects the medical risk of
pregnancy and level of fertility in a population.

5. CAUSES OF MATERNAL DEATH
 Causes of maternal death can be classified into 3 categories-
 Direct deaths
 Indirect deaths
 Incidental deaths
A woman is most vulnerable during at the post partum period. About 50-
70 percent maternal deaths occur in the postpartum period of which 45
percent deaths occur in the first 24 hours after delivery and more than
two third during the first week. Between 11-17 percent of maternal
deaths occur during child birth.

6. DIRECT CAUSES
 Direct maternal deaths relate to deaths resulting from complications of
pregnancy, labour or the puerperium due to interventions, omissions or
incorrect treatments or from a chain of events resulting from any of the
above.
 Amongst the leading causes of direct maternal deaths are haemorrhage,
sepsis, pre-eclampsia and eclampsia, abortions and obstructed labour.
 Almost 66 percent of deaths are due to direct cause,
most of which are largely preventable

7.  Haemorrhage: The most common single preventable cause is haemorrhage. It
is responsible for 25 to 50%/(average 37%) deaths. Atonic postpartum
haemorrhage is the most important cause followed by antepartum
haemorrhage, bleeding from abortions, rupture uterus and ectopic pregnancy.
 Sepsis: About 11% of maternal deaths are caused by sepsis like puerperal
sepsis. Septic abortions are responsible for 8% of all maternal deaths.
 Pre-eclampsia and eclampsia: These account for almost 5% of all maternal
deaths with most women being without prenatal care.
 Prolonged and obstructed labour: About 5 of women die as a result of
prolonged, neglected and obstructed labour due to dehydration, exhaustion
and infection. They may suffer from uterine rupture or septic or hemorrhagic
shock.

8. The most common single preventable cause is
haemorrhage. It is responsible for 25 to 50%/(average
37%) deaths. Atonic postpartum haemorrhage is the
most important cause.

9. INDIRECT MATERNAL DEATHS
 Indirect maternal deaths include deaths resulting from previous
existing diseases or diseases that developed during pregnancy but
got worsened by physiological effects of pregnancy or stress of
labour. They cause about 34% maternal deaths. It includes diseases
like anemia, heart disease, hepatitis and tetanus.

10.  Anaemia: It accounts for (12-15%) of all maternal deaths and is a contributory
factor in many other deaths. The women may die during pregnancy or labour due
to congestive cardiac failure.
 Hepatitis: Pregnant women are 7-10 times more likely to suffer from hepatic
failure, coma, coagulation failure, postpartum haemorrhage and death. During
an epidemic, hepatitis may account for 10 to 15% of all maternal deaths. In
some parts of North India like Delhi, hepatitis especially Hepatitis E is the
leading cause of maternal mortality due to hepatic coma.
 Heart disease: Heart disease accounts for 5% of all maternal deaths with
rheumatic heart disease with a tight mitral stenosis being particularly
vulnerable for mortality.
 Tetanus: About 1% maternal deaths result from tetanus. Routine administration
of tetanus toxoid to all pregnant women as part of prenatal care has helped to
protect many lives

11. haemorrhage
37%
sepsis
11%
unsafe abortions
8%
hypertensive disorder
5%
obstructed labour
5%
other clinical causes
2%
anaemia
13%
other indirect causes
13%
unclassified
6%
INDIRECT CAUSES OF MATERNAL DEATHS
haemorrhage sepsis unsafe abortions hypertensive disorder obstructed labour
other clinical causes anaemia other indirect causes unclassified

12. INCIDENTAL MATERNAL DEATHS
 Incidental maternal deaths are those deaths which result from accidents,
malignant neoplasms, etc. They are not counted in maternal mortality and
are called non-maternal deaths.

13. OTHER FACTORS AFFECTING MATERNAL
DEATHS
 WOMEN’S AGE- the optimal child bearing age is between 20 to 30 years. The
further away from this range, the greater the risks of a woman dying from
pregnancy and childbirth.
 SHORT BIRTH INTERNVAL-It is associated with increased risk of maternal
mortality.
 HIGH PARITY- high parity contributes to maternal mortality

14. LATE MATERNAL DEATHS
 It is "the death of a woman from direct or indirect obstetric causes, after
more than 42 days but less than one year after termination of pregnancy".
Like maternal deaths, late maternal deaths also include both direct and
indirect maternal/obstetric deaths.
 Maternal deaths and late maternal deaths are combined n the 11th revision of
the ICD under the new grouping of “comprehensive maternal deaths”.

15. PREGNANCY RELATED DEATHS
 also known as death occurring during pregnancy, childbirth and
puerperium: 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
obstetric and non-obstetric)": this definition includes
unintentional/accidental and incidental causes.

16. INTERVENTIONS TO PREVENT MATERNAL
DEATHS
 Promotion of family planning services, delay in age of marriage and child birth
 Early registration of pregnancy and hospital follow ups
 Dietary supplementation and prophylaxis for anemia
 Presence of skilled attendants at delivery and provision for safe abortions
 Functional referral system to facilities that provide comprehensive obstetric
care
 Integrated management of indirect causes of maternal mortality by different
departments
 Good anaesthetic facility and blood banks
 Maternal mortality review meetings

17. Global Strategy for Women's. Children's
and Adolescent's Health 2016-2030
 launched in the year 2015 with a vision to have by the year 2030, a "world in
which every woman, child and adolescent in every setting realize their rights
to physical and mental health and well being, has social and economic
opportunities and is able lo Participate fully in shaping prosperous and
sustainable society".
 It seeks to end all preventable deaths of women, children and adolescents
and create an environment in which these groups not only survive, but thrive,
and see their environments, health and wellbeing transformed.
 The global strategy goals of SURVIVE ,THRIVE and TRANSFORM and the
targets to be achieved by 2030

21. MMR in India