MATERNAL MORTALITY

MARISSA S. FERNANDEZ, RN, MAN

• Key facts:
• Every day in 2017, approximately 810 women died from preventable causes
related to pregnancy and childbirth.
• Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal
deaths per 100,000 live births) dropped by about 38% worldwide.
• 94% of all maternal deaths occur in low and lower middle-income countries.
• Young adolescents (ages 10-14) face a higher risk of complications and death as
a result of pregnancy than other women.
• Skilled care before, during and after childbirth can save the lives of women and
newborns.
• Where do maternal deaths occur?
• The risk of maternal mortality is highest for adolescent girls under 15 years
old and complications in pregnancy and childbirth are higher among
adolescent girls age 10-19 (compared to women aged 20-24) (2,3).
• Women in less developed countries have, on average, many more pregnancies
than women in developed countries, and their lifetime risk of death due to
pregnancy is higher.
• A woman’s lifetime risk of maternal death is the probability that a 15 year
old woman will eventually die from a maternal cause. In high income countries,
this is 1 in 5400, versus 1 in 45 in low income countries.
• The major complications that account for nearly 75% of all maternal deaths
are (4):
• 1. severe bleeding (mostly bleeding after childbirth)
• 2. infections (usually after childbirth)
• 3. high blood pressure during pregnancy (pre-eclampsia and eclampsia)
• 4. complications from delivery
• 5. unsafe abortion.
• The remainder are caused by or associated with infections such as malaria or
related to chronic conditions like cardiac diseases or diabetes.
• Most maternal deaths are preventable, as the health-care solutions to prevent
or manage complications are well known.
• All women need access to high quality care in pregnancy, and during and
after childbirth.
• Maternal health and newborn health are closely linked. It is particularly
important that all births are attended by skilled health professionals, as timely
management and treatment can make the difference between life and death
for the mother as well as for the baby.
• Management and treatment can make the difference between life and death
for the mother as well as for the baby.
• 1. Severe bleeding after birth can kill a healthy woman within hours if she is
unattended. Injecting oxytocics immediately after childbirth effectively
reduces the risk of bleeding.
• 2. Infection after childbirth can be eliminated if good hygiene is practiced
and if early signs of infection are recognized and treated in a timely manner.
• 3. Pre-eclampsia should be detected and appropriately managed before the
onset of convulsions (eclampsia) and other life-threatening complications.
Administering drugs such as magnesium sulfate for pre-eclampsia can lower a
woman’s risk of developing eclampsia.
• Main factors that prevent women from receiving or seeking care during
pregnancy and childbirth are:
• 1. poverty
• 2. distance to facilities
• 3. lack of information
• 4. inadequate and poor quality service
• 5. cultural beliefs and practices.
• To improve maternal health, barriers that limit access to quality maternal
health services must be identified and addressed at both health system and
societal levels.
• "Three Delays" model proposes that pregnancy-related mortality is
overwhelmingly due to delays in:
• (1) deciding to seek appropriate medical help for an obstetric emergency;
(2) reaching an appropriate obstetric facility; and
• (3) receiving adequate care when a facility is reached.
• WHO response
• Improving maternal health is one of WHO’s key priorities. WHO works to contribute to the
reduction of maternal mortality by increasing research evidence, providing evidence-based
clinical and programmatic guidance, setting global standards, and providing technical support
to Member States on developing and implementing effective policy and programmes.
• 1. addressing inequalities in access to and quality of reproductive, maternal, and newborn
health care services;
• 2. ensuring universal health coverage for comprehensive reproductive, maternal, and newborn
health care;
• 3. addressing all causes of maternal mortality, reproductive and maternal morbidities, and
related disabilities;
• 4. strengthening health systems to collect high quality data in order to respond to the needs
and priorities of women and girls; and
• 5. ensuring accountability in order to improve quality of care and equity.
• MATERNAL MORTALITY RATE = is the number of resident maternal deaths within
42 days of pregnancy termination due to complications of pregnancy, childbirth, and
the puerperium in a specified geographic area (country, state, county, etc.) divided
by total resident live births for the same geographic area for a specified time
period, usually a calendar year, multiplied by 100,000.
• Calculation:
• (Number of resident maternal deaths/Number of resident live births) x 100,000
Examples:
84 maternal deaths in 2008 among state residents
130,000 live births in 2008 to state residents
84/130,000 x 100,000 = 64.6 maternal deaths per 100,000 live births in 2008
among state residents
• Philippines - Maternal mortality ratio
• 121.0(deaths per 100,000 live births)in 2017
• In 2017, maternal mortality ratio for Philippines was 121 deaths per
100,000 live births.
• Maternal mortality ratio of Philippines fell gradually from 156 deaths per
100,000 live births in 2003 to 121 deaths per 100,000 live births in 2017
 MATERNAL MORBIDITY

• Maternal morbidity is an overarching term that refers to any physical or mental

illness or disability directly related to pregnancy and/or childbirth. These are not
necessarily life-threatening but can have a significant impact on the quality of life.
• WHO - “any health condition attributed to and/or aggravated by pregnancy and
childbirth that has a negative impact on the woman’s wellbeing”
• Morbidity - Refers to having a disease or a symptom of disease, or to the amount
of disease within a population. Morbidity also refers to medical problems caused by
a treatment.
• Maternal morbidity includes a range of different health conditions. Some of
them start during pregnancy and last only a short time, while others do not
develop until years after a pregnancy and continue throughout the woman’s
life.
• Maternal mortality usually results from a pregnancy, delivery, or postpartum
complication; a chain of medical events started by the pregnancy or delivery;
the worsening of an unrelated condition because of the pregnancy or
delivery; or other factors.1
• Maternal Morbidity:
• Maternal health problems related to pregnancy and giving birth can occur during pregnancy,
during delivery, and after a pregnancy ends. Some common examples of maternal morbidity
include the following2:
• 1. Cardiovascular problems, such as heart disease and blood vessel problems
• 2. Diabetes
• 3. High blood pressure
• 4. Infections, especially from cesarean section
• 5. Blood clots
• 6. Bleeding (sometimes called hemorrhage)
• 7. Anemia (low iron in the blood)
• 8. Nausea and vomiting (sometimes called morning sickness) and hyperemesis gravidarum
(severe morning sickness)
• 7. Depression and anxiety
• What is an example of Morbidity?
• Morbidity is when you have a specific illness or condition. Some examples of
common morbidities are heart disease, diabetes, and obesity. You can have more
than one morbidity at a time.
• Can maternal morbidity be prevented?
• Because many factors play a role in maternal morbidity and mortality, there is no
single way to prevent maternal health problems and deaths.
• How can Morbidity be prevented?
• Primary prevention, through provision of safe and adequate
food/water/sanitation, appropriate shelter and site planning, immunization of
vulnerable populations, institution of vector control measures and health
education on hygiene/hand-washing, and prevention of CDs as well as dietary
and feeding practices.
• How do you calculate maternal morbidity rate?
• The maternal mortality ratio can be calculated by dividing recorded (or
estimated) maternal deaths by total recorded (or estimated) live births in
the same period and multiplying by 100,000.
• Factors of morbidity:
• A morbidity rate is the rate at which acute and chronic diseases occur in a
population.
• Morbidity rates can be used to determine the overall health of a population
and to determine its health care needs.
• Why is morbidity important?
• Morbidity statistics measure the extent of a nation's health and provision of
health facilities. These data could be used to measure the extent to which medical
facilities are utilized. They could help, too, in the investigation of the patterns of
occurrence of illness.
• Making Pregnancy Safer:
• 1. The education of women.
• 2. An increase in the use of contraception.
• 3. More prenatal care.
• 4. More births in hospitals or with skilled health care providers present.
• 5. Greater availability of antibiotics, blood transfusions, and treatments for
complications.
• A Neonatal death (also called a newborn death) is when a baby dies during
the first 28 days of life. Most neonatal deaths happen in the first week after
birth. Neonatal death is different from stillbirth. A stillbirth is when the baby
dies at any time between 20 weeks of pregnancy and the due date of birth.
• Why is neonatal mortality important?
• Infant mortality rate, measure of human infant deaths in a group younger than
one year of age.
• It is an important indicator of the overall physical health of a community.
... High infant mortality rates are generally indicative of unmet human health
needs in sanitation, medical care, nutrition, and education.
 • Neonatal Mortality Rate
• Neonates. Globally 2.4 million children died in the first month of
life in 2019. There are approximately 6 700 newborn deaths
every day, amounting to 47% of all child deaths under the age of
5-years, up from 40% in 1990. The world has made substantial
progress in child survival since 1990.
• Neonatal mortality rate (NMR) or infant mortality rate (IMR)
are the rate of deaths per 1,000 live births at which babies of
either less than four weeks or of one year of age die, respectively.
The NMR and IMR are commonly accepted as a measure of the
general health and wellbeing of a population.
• How do you calculate neonatal mortality rate?
• The neonatal death rate is calculated as the number of infant deaths that
occur between 0-27 days of life (often referred to as the 1st month of
life) divided by the number of live births, multiplied by 1000.
• What is the neonatal mortality age range?
• Definitions of indicators
Under-five mortality rate: Probability of dying between birth and exactly 5
years of age, expressed per 1,000 live births.
• Infant mortality rate: Probability of dying between birth and exactly 1
year of age, expressed per 1,000 live births.
• Causes of newborn death:
The three major causes of neonatal deaths worldwide are
• 1. infections (36%, which includes sepsis/pneumonia, tetanus and
• 2. diarrhoea), pre-term (28%), and
• 3. birth asphyxia (23%). There is some variation between countries depending on their care
configurations.
• The five leading causes of infant death in 2018 were:
• 1. Birth defects.
• 2. Preterm birth and low birth weight.
• 3. Maternal pregnancy complications.
• 4. Sudden infant death syndrome.
• 5. Injuries (e.g., suffocation).