Causes of Maternal Mortality:

1)Severe bleeding- 25%

2)Indirect Causes -20% eg anaemia,malaria and heart disease.

3)Infection- 15%

4)Eclampsia-12%

5)Unsafe abortion-13%

6)Obstructed labour-8%

7)Other direct causes-eg embolism, ectopic pregnancy and anaesthesia related.

The causes of maternal mortality are the same in developed and developing countries.However there is variation in the common causes of maternal mortality, in the developed countries the common causes are thrombosis/thromboembolism,hypertensive disease and cardiac disease, while in the developing countries haemorrhage, sepsis and hypertension tops the list.

Causes of maternal mortality in developed countries:

Direct deaths (In descending order of incidence)

Thrombosis and thromboembolism

Hypertensive disease

Amniotic fluid embolism

Early pregnancy deaths due to ectopic pregnancy, spontaneous miscarriage and legal termnation

Sepsis

Haemorrhage

Genital tract trauma

Other direct causes

Indirect deaths (In descending order of incidence)

Cardiac disease

Psychiatric disorder

Other indirect causes

Direct causes account for about 80% of maternal deaths, the remaining 20% are due to indirect causes.

Social factors that influence maternal mortality:

i)Women’s age: The optimal child bearing age is from 20 to 30 years. There is a gradual increase in the risk of maternal mortality <20 years and >30 years.

ii)Parity: Parity means the number of children. The higher the parity, the higher will be the maternal mortality.

iii)Birth interval: There is an increase risk of maternal mortality with short birth intervals.

iv) Poor socioeconomic status.

v) Bad cultural practices and beliefs.

vi) Nutritional status-eg malnutrition

vii) Environmental factors-eg poor environmental sanitation.

vii)Literacy

viii)Lack of maternity services

ix) Shortage of manpower in the health sector

x) Poor communications and transport facilities.

Important measures to reduce maternal mortality:

i)Early registration of pregnancy.

ii)A minimum of three antenatal check-ups.

iii) Correction of anaemia and dietary supplementation.

iv) Prevention of haemorrhage and infection during the puerperium.

v) Prophylaxis against malaria and tetanus.

vi) Delivery in a very clean environment.

vii)Treatment of medical conditions such as diabetes, tuberculosis and hypertension.

viii)Institutional delivery for women with bad obstetric history and high risk factors.

ix) Training of traditional birth attendants and female health care workers.

x) Promotion of family planning.

xi) Prevention of complications such as eclampsia, malpresentations and ruptured uterus.

xii) Searching for the cause of every maternal death.

References:

Maternal mortality ,pages 20 to 27. Chapter 3.Obstetrics by Ten Teachers. 17th Edition. Edited by Stuart Campbell and Christoph Lees.

Pages 387 to 389. Maternal Mortality Rate.Chapter 9.Preventive Medicine in Obstetrics,Paediatrics and Geriatrics.Park’s Textbook of Preventive and Social Medicine by K. Park. 17th Edition.

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