Causes of Maternal Mortality and Morbidity

7/31/2019 Causes of Maternal Mortality and Morbidity

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is defined as the death of a woman whilepregnant or within 42 days of termination ofpregnancy from any cause related to or aggravated

by the pregnancy or its management.

Maternal morbidity is any illness or injury caused

or aggravated by, or associated with, pregnancy orchildbirth.


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total number of female death due to

complication of pregnancy , childbirth or

within 42 days of delivery frompuerperal causes in an area during a

given year by total no of live births in

same area of year.


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Maternal mortality continues to be the majorcause of death among women of reproductive

age in many countries . One of the most important

indicators for maternal health is maternalmortality. The exact figure for the maternalmortality ratio in Nepal is not clear, although it is

generally agreed that it has decreased. However, itis very clear that the MMR is still high which meansthe suffering of pregnant women in Nepal remainsa reality.


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Sources MMR per 100,000 live births

Nepal Family Planning, Fertility and Health Survey,(1991 ) -

515 WHO/UNICEF estimate in 1996 - 826 Nepal Family Health Survey, 1996 - 539 UNICEF, 1990-2005, reported - 540

UNICEF, 2000, adjusted - 740 WHO, 2000 as reported in WHO Mortality Country Fact

sheet, 2006 - 740 Nepal Family Health Survey, 2006 - 281


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The causes of maternal deaths may beeither direct, such as obstetric

complications ofpregnancy, delivery and the

puerperium, or indirect, such as pre -existing diseases or diseases

developed during the pregnancy that

are made worse by pregnancy.


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About 80 percent of maternal deaths are due tocauses that are directly related to childbirth and

pregnancy. The five major direct causes ofmaternal death are: Hemorrhage sepsis,hypertensive disorders, prolonged or obstructedlabor and unsafe abortion. Most of theseconditions could be prevented with propermedical monitoring, information and services


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1st leading cause of maternal death in Nepal. Itrefers to bleeding after delivery of placenta. Themain causes of PPH includes atonic uterus, trauma

to the birth canal and blood coagulation disorders.2.Infection

It is the 2nd most common cause of maternal deathin developing countries.the major cause ofinfection is the entry of germs into the genital tractthrough the use of unwashed hands andunsterilized instruments during delivery or vaginal

examinations.and complication of illegal abortion


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In developing countries hypertensive disorder is oftenseen in a very young and primi pregnant.causes areunknown. It is the 3rd most cause of maternal death.

4.Obstructed labour It is caused by mainly cephalopelvic disorder or caused

by abnormal position of fetus and placenta and therupture of uterus is subsequent causes.

In addition obstructed labour is direct cause of oneof the most distressing form long term morbidityresulting from post pregnancy complications eg:vasico-vaginal fistula, recto-vaginal fistula, uterineproplapse etc.


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Unsafe abortion is both wide and

major cause of maternal death indeveloping countries. About 40-

60 million women a year seek

termination of an unwantedpregnancy.


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Post partum haemorrnage 47% Obstructed labour 16%

Hypertensive disorder 14% Infection 12%

Abortion 5% Others(ectopic pregnancy, embolism)

6%


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The study reported that the % of maternal deathduring pregnancy, childbirth and puerperium are

as follows Less than 24 weeks of pregnancy 11.4% More than or equal to 24 weeks of

pregnancy 16.6% Durind labour 9.9% After delivery up to 42 days 62%


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The survey reported that among all thematernal death occurs:

At home :68% On the way to health facility :11% At health facilities :21%


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Approximately 20 percent of maternal

deaths arise from pre-existing conditions

that are aggravated by pregnancy, suchas anemia, one of the primary indirectcauses, and malaria, hepatitis, heart

disease and HIV/AIDS.


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Other attributed factors for high maternal mortality are the'three delays'

delay in taking the decision to seek medical assistance,

low socio-economic status of women, Lack of awareness :- Lack of decision-making power,

excessive physical labor and poor nutrition also affectmaternal mortality.

delay in accessing appropriate care mountainous land-locked country- distance from health

facility Lack of transport from home to health facility


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and delay in receiving care at health centres Refusal of treatment on admission No communication with the referring health

facility Shortage of skilled human resources Shortage of expertise, training or education

Shortage of blood transfusion Shortage of essential drug Shortage of equipment Others :Lack of monitoring the patient in ward,

delay in starting drugs etc


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Additional factors that prevent womenin developing countries from receiving

the life-saving health care they needinclude distance from health services,

costs, poor quality of available servicesand substandard treatment by health

providers.


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mothers age (below 20 or above

35)

birth interval (less than 2 years)

parity (high parity more than 5)

Cultural practices and beliefs


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Forty-two percent of the 129 million women

who give birth annually experience some

complications during pregnancy.

Approximately 15 percent of women

worldwide develop potentially life-threatening complications, which include

chronic pain, impaired mobility, damage to

the reproductive system and infertility.


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Causes of Maternal Mortality and Morbidity

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