Maternal mortality refers to the death of a woman during pregnancy or within 42 days of termination of pregnancy from pregnancy-related causes. The document discusses the types and major causes of direct and indirect maternal deaths. It also defines various measures of maternal mortality like maternal mortality ratio, rate, and lifetime risk. Key statistics on global and regional maternal mortality are provided. The major medical and social determinants of maternal mortality are discussed.

1. MATERNAL MORTALITY
CAUSES
B.RAMESH
ROLL No. 16

2. WHAT IS 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 causes.”

3. TYPES
According to ICD :
1. DIRECT OBSTETRIC DEATHS
2. INDIRECT OBSTETRIC DEATHS

4. DIRECT OBSTETRIC DEATHS
These result from 5 major causes
1. Haemorrhage esp. PPH
2. Sepsis
3. Eclampsia
4. Obstructed labour
5. Unsafe abortions.

5. INDIRECT OBSTETRIC DEATHS
Results from previously existing diseases
or from diseases arising during
pregnancy which are aggravated by the
physiological effects of pregnancy.
E.g.:
Malaria,
Anaemia,
HIV/AIDS,
Cardiovascular disorders,
Diseases of Endocrine & metabolic
systems.

6. Measures of Maternal Mortality
1. MATERNAL MORTALITY RATIO
Represents the risk associated
with each pregnancy i.e, the obstretic
risk. It is calculated as the no. of
maternal deaths during a given year per
1 lakh live births during the same period.
Although the measure has traditionally
been referred to as a rate it is actually a
ratio.

7. Note:
The appropriate denominator for the
maternal mortality ratio would be the total
numbers of pregnancies [live births, fetal
deaths (stillbirths), induced and
spontaneous abortions, ectopic and molar
pregnancies ].However, this figure is
seldom available, either in developing
countries where most births take place or
in developed countries, and so the number
of live births is generally used as the
denominator.

8. 2.Maternal Mortality Rate
Measures both the obstretic
risk & the frequency with which women
are exposed to this risk. It is calculated
as the no. of maternal deaths in a given
period per 1 lakh women reproductive
age (usually 15 to 49 years).
The terms “ratio” and “rate”
are often used interchangeably; for the
sake of clarity it is therefore essential,
when referring to either of these
measures of maternal mortality, to
specify the denominator used.

9. 3. Life Time Risk Of Maternal Death
Takes into account both the
probability of becoming pregnant &
the probability of dying as a result
of the pregnancy cumulated across
a woman’s reproductive years.

10. The lifetime chances of maternal death in
the world is about 1 in 75.
In the least developed countries 1 in16.
In the developing countries 1 in 60.
In the industrialized countries 1 in 4100.
In Sub-Saharan region the chances are 1
in 13 pregnancies.

11. LATE MATERNAL DEATH :-
“The death of a woman from direct or
indirect obstetric causes more than 42
days but less than 1 year after
termination of pregnancy.”
PREGNANCY RELATED DEATH:-
“The death of a woman while
pregnant or within 42 days of termination
of pregnancy, irrespective of the cause
of the death.”

12. INCIDENCE
Global Scenario
According to WHO estimates about
5,10,000 maternal deaths occurred globally
in the year 2002. Of these
2,31,000 occurred in African countries
17,000 in America
68,000 in eastern Mediterranean
3,000 in European countries
1,71,000 in SEAR countries

13. NEIGHBOURING
COUNTRIES
SNo. NATION MMR
1 India 407
2 Afghan 820
3 Bangladesh 380
4 Nepal 740
5 Pakistan 500
6 Sri lanka 30
7 China 56
8 Myanmar 360
9 Thailand 44
DEVELOPED COUNTRIES
SNo. NATION MMR
1 Greece 10
2 Finland 05
3 Canada 05
4 Australia 06
5 Sweden 08
6 Israel 13
7 U.K 11
8 Japan 10
9 Singapore 15

14. Source RGI RGI Bhat IIHW@
STATE 1997 1998 1994 1998-99
Punjab 196 199 289 351
Haryana 105 103 289 468
U.P 707 707 612 737
Rajasthan 677 670 588 526
Maharashtra 135 135 477 365
Gujarat 29 28 477 393
A.P 154 159 383 341
Tamil Nadu 76 79 383 284
INDIA 408 407 544 466

15. Socio economic variations in MMR
Characteristics Sub categories MMR (per lakh)
Caste
SC 584
ST 652
Others 516
Religion
Hindu 573
Muslim 384
Others 428
Education
Illiterate 574
Literate 480
Socio economic
status
Poor 555
Middle 479
Non poor 484

16. Causes of Maternal Mortality
Anaemia
19%
Hemorrhage
29%
Obstructed
Labour
10%
Abortion
9%
Others
9%
Toxaemia
8%
Sepsis
16%

17. Determinants of maternal mortality
• Medical Factors • Social Factors
• Obstetric • Non Obstetric

18. Obstetric Causes
Haemorrhage
Infection
Obstructed labour
Unsafe Abortion
Hypertensive disorders of Pregnancy

19. Non obstetric causes
Anaemia
Associated diseases
Malignancy
Accidents

20. Social Factors
Women’s age
Birth spacing
Parity
Malnutrition
Environmental conditions
Lack of adequate services
Others.

21. “Regarding maternal deaths,
we know the causes. We have the
solutions for most cases. We have
begun to make a difference.”

22. Thank you