VITAL STATISTCS in OBSTETRICS

1. VITAL STATISTCS in OBSTETRICS Dr. Haifaa A. Mansouri FRCS Canada

2. Vital statistics: Vital statistics are parameters of health care These include: maternal mortality rate, ratio perinatal mortality (PNM) neonatal mortality (NNM) fetal mortality Definitions Causes of maternal and perinatal mortality Measures for prevention/reduction of maternal & fetal morbidity & mortality.

3. Vital Statistics of USA 1900 : first standard certificate of live births and deaths Bureau of Census 1902:annual collection of vital statistics United States Public Health Service: 1946 transferred National Center for Health Statistics (NCHS): division of vital statistics

4. Contd : NCHS part of CDC Function to collaborate with state vital statistics offices to revise certificates of live birth & fetal death. Every 10-15 years Revisions usually followed by implementation 2003 revision: collection of data-accuracy, electronic processing, more demographic data

5. Vital Statistics of KSA ????? ????????? ??????: ????? 1379? ?????? ???????? ??????1424

6. Definitions Use of standard definitions WHO, AAP & ACOG This allows comparison of data between states regions and countries Definitions used are recommended by NCHS & CDC

7. Maternal Mortality The no. of maternal deaths that result from the reproductive process per 100,000 live births. WHO within 42 days of termination of pregnancy ICD 10 (ICD 9 within a year)

9. Late maternal deaths Deaths of woman from direct or indirect obst >42 days but < 1 year

10. Pregnancy related deaths The death of a woman while pregnant or within 42 days( the same as WHO)

11. Contd Direct maternal death: result from Obstet. Complics. Of preg, labor or puerperium & from interventions, omissions, incorrect treatment or a chain of events resulting from any of these factors. Indirect maternal death: result from previously existing disease, or a dis. That developed during pregnancy, labor or puerperium, but which aggravated by maternal physiological adaptation to preg

12. Contd Nonmaternal death: resultingfrom accidental or incidental causes not related to pregnancy

13. Contd: Pregnancy associated death: death of any women while pregnant or within 1 calendar yr of termination of pregnancy regardless of duration or site pregnancy-related death: resulting from: 1- complication of preg 2-chain of events initiated by preg that led to death 3- aggravation of unrelated condition by the physiological or pharmacological effects of preg that subsequently caused death.

14. Perinatal mortality Perinatal period: period after birth of 500 g or more ending at 28 completed days after birth. GA: 20 w Birth rate: no of live births per 1000 population Fertility rate: no of live births per 1000 females aged 15 through 44 y

15. Contd Live birth: NB breathes at birth spontaneously or shows any other sign of life as heartbeat or definite spontan of voluntary muscles. Stillbirth or fetal death: The absence of signs of life at or after birth. neonatal death: Early NND refers to death of a liveborn neonate during the first 7 days but before 29 days

16. Contd Stillbirth rate or fetal death rate: no of stillorn neonates per 1000 neonates born Neonatal mortality rate: no of NND per 1000 live births Perinatal mortality rate: no of stillbirths plus NND per 1000 total births

17. Contd : Infant death: all deaths of liveborn infants from birth thru 12 months of age Infant mortality rate: no of infant deaths per 1000 live births

18. Contd : Low-birth weight : NB whose wt <2500 g Very-low birth weight: <1500 g Extremely-low birth weight: <1000 g

19. Contd : Term neonate: a neonate born anytime after 37 completed w of gestation & up to until 42 w (260-294) Preterm neonate: before 37 completed w (the 259th day) Post term neonate: after completion of the 42nd w beginning day 295

20. Women Health in a global perspective .WHO No issue is more central to global well-being than maternal and perinatal health. Every individual, every family and every community is at some point intimately involved in pregnancy and the success of childbirth. Yet every day, 1600 women and over 10000 newborns die due to complications that could have been prevented.

21. Contd : The key goal of the Department is to provide technical support and through building national capacity for managed care and universal coverage, to ensure skilled care for every birth within the context of a continuum of care. Integrated Management of Pregnancy and Childbirth (IMPAC) will help shape technical support to countries in strategic and systematic ways to improve maternal, perinatal and newborn health

22. Contd Since its inception in January 2005, the Department of Making Pregnancy Safer (MPS) at the World Health Organization, sets out a way forward for making pregnancy and childbirth safer for women and their newborns, and thus accelerating the reduction of maternal and perinatal mortality and morbidity - especially in the developing world, where 98% of these deaths occur.

25. Accelerating Efforts to Save the Lives of Women and Newborns�Every minute a woman dies in pregnancy or childbirth, over 500,000 every year. And every year over one million newborns die within their first 24 hours of life for lack of quality care. Maternal mortality is the largest health inequity in the world; 99 per cent of maternal deaths occur in developing countries � half of them in Africa. A woman in Afghanistan faces a 1 in 8 chance during her lifetime of dying of pregnancy�related causes, while a woman in Sweden has 1 chance in 17,400.�On 25 September 2008, as world leaders gather for the High-Level Event on the Millennium Development Goals (MDGs), WHO, UNFPA, UNICEF and the World Bank jointly pledged to intensify their support to countries to achieve Millennium Development Goal 5 �To Improve Maternal Health� � the MDG showing the least progress.�During the next five years, we will enhance support to the countries with the highest maternal mortality. We will support countries in strengthening their health systems to achieve the two MDG 5 targets of reducing the maternal mortality ratio by 75 per cent and achieving universal access to reproductive health by 2015. Our joint efforts will also contribute to achieving MDG 4 �To Reduce Child Mortality�.�Fortunately, the vast majority of maternal and newborn deaths can be prevented with proven interventions to ensure that every pregnancy is wanted and every birth is safe.WHO, UNFPA, UNICEF and the World Bank will work with governments and civil society to strengthen national capacity to:Conduct needs assessments and ensure that health plans are MDG�driven and performance�based; Cost national plans and rapidly mobilize required resources; Scale-up quality health services to ensure universal access to reproductive health, especially for family planning, skilled attendance at delivery and emergency obstetric and newborn care, ensuring linkages with HIV prevention and treatment; Address the urgent need for skilled health workers, particularly midwives; Address financial barriers to access, especially for the poorest; Tackle the root causes of maternal mortality and morbidity, including gender inequality, low access to education � especially for girls, child marriage and adolescent pregnancy; Strengthen monitoring and evaluation systems. 

26. Accelerating Efforts to Save the Lives of Women and Newborns�Every minute a woman dies in pregnancy or childbirth, over 500,000 every year. And every year over one million newborns die within their first 24 hours of life for lack of quality care. Maternal mortality is the largest health inequity in the world; 99 per cent of maternal deaths occur in developing countries � half of them in Africa. A woman in Afghanistan faces a 1 in 8 chance during her lifetime of dying of pregnancy�related causes, while a woman in Sweden has 1 chance in 17,400.�On 25 September 2008, as world leaders gather for the High-Level Event on the Millennium Development Goals (MDGs), WHO, UNFPA, UNICEF and the World Bank jointly pledged to intensify their support to countries to achieve Millennium Development Goal 5 �To Improve Maternal Health� � the MDG showing the least progress.�During the next five years, we will enhance support to the countries with the highest maternal mortality. We will support countries in strengthening their health systems to achieve the two MDG 5 targets of reducing the maternal mortality ratio by 75 per cent and achieving universal access to reproductive health by 2015. Our joint efforts will also contribute to achieving MDG 4 �To Reduce Child Mortality�.�Fortunately, the vast majority of maternal and newborn deaths can be prevented with proven interventions to ensure that every pregnancy is wanted and every birth is safe.WHO, UNFPA, UNICEF and the World Bank will work with governments and civil society to strengthen national capacity to:Conduct needs assessments and ensure that health plans are MDG�driven and performance�based; Cost national plans and rapidly mobilize required resources; Scale-up quality health services to ensure universal access to reproductive health, especially for family planning, skilled attendance at delivery and emergency obstetric and newborn care, ensuring linkages with HIV prevention and treatment; Address the urgent need for skilled health workers, particularly midwives; Address financial barriers to access, especially for the poorest; Tackle the root causes of maternal mortality and morbidity, including gender inequality, low access to education � especially for girls, child marriage and adolescent pregnancy; Strengthen monitoring and evaluation systems. 

29. Causes of maternal mortality Embolism: no 2 in USA 2003 published 2006 Hemorrhage: no 3 in USA .cause 50%MM in developing world Hypertensive disorders: no 1in USA Infection Cardiomyopathy CVA Anesthesia Other unknown

30. Causes of infant deaths 28025 infant deaths in USA Two thirds were neonatal deaths By birth weight : 2/3ds were low birth weight neonates The rate: 6.85 per 1000 live births Death rate in Saudi Arabia 18.5 per 1000 live birth

31. Contd Congenital malformations preterm & LBW SIDS newborn affected by maternal complications of preg Complications of cord & placenta Accidents RDS Bacterial sepsis Neonatal hemorrhage

32. Measures for prevention /reduction of maternal & fetal morbidity & mortality Primary measures: promotion of population health at society Secondary measures: healthy pregnancy & delivery & prevent complications Tertiary measures: prompt & efficient treatment of high risk conditions and complications

33. Vital statistics: USA vs KSA MMR: 7.5 (2002) 12 (2003) vs 14 (2000) Infant deaths:6.85 (2003) vs 19.1 (2000) and 18.5 (2007) NNM:4.62 (2003) vs NA Birth rate: 13.9 (2002) vs 27.8 (2000) and 25.3 (2007) Life expectancy at birth: 77.5 vs 71.9

34. Thank you