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Maternal mortality rate in Yazd-Iran during 10 years (2002-2011)

Maternal mortality rate in Yazd-Iran during 10 years (2002-2011). DR.Karimi Zarchi M Gynecological oncology felloship, shahid sadoughi university of Medical Sience. Definitions. Definition. Implications. Maternal death

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Maternal mortality rate in Yazd-Iran during 10 years (2002-2011)

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  1. Maternal mortality rate in Yazd-Iran during 10 years (2002-2011) DR.Karimi Zarchi M Gynecological oncology felloship, shahid sadoughi university of Medical Sience

  2. Definitions Definition Implications Maternal death The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its managementbut not from accidental or incidental causes. • Death must be attributed directly or indirectly topregnancy or childbirth • Requires medical certification or verbal autopsy • Cannot be obtained through surveys or censuses • No deaths beyond 42 days due to pregnancy complications accounted for Pregnancy-related death The death of a woman while pregnant or within 42 daysof termination of pregnancy, irrespective of the cause of death. • Cause of death certification not needed • Can be obtained through surveys or censuses UN Interagency maternal mortality estimates conform to the definition of maternal death

  3. Maternal Mortality: A Global Tragedy • Annually, 536,000 women die of pregnancy related complications • 99% in developing world • ~ 1% in developed countries • 25% global burden by India Every minute one Maternal Death occur Current Approach to Reduction of Maternal Mortality

  4. Maternal Death Watch • 380 women become pregnant • 190 women face unplanned or unwanted pregnancy • 110 women experience a pregnancy related complication • 40 women have an unsafe abortion • 1 woman dies from a pregnancy-related complication Current Approach to Reduction of Maternal Mortality

  5. The fifth MDG(Millennium Development Goal) aims to improve maternal health, with a target of reducing the MMR by 75% between 1990 and 2015. The percentage reductions for the 10 countries that have already achieved MDG 5 by 2010 are: Estonia(95%), Maldives(93%), Belarus(88%), Romania(84%), Bhutan(82%), Islamic Republic of Iran(81%), Equatorial Guinea(81%), Lithuania(78%), Nepal(78%) and Viet Nam(76%)

  6. Estimates of maternal mortality ratio,number of maternal deaths by United National Millennium Development Goal region,2013

  7. Trends in estimates of maternal mortality ratio(maternal deaths per 100000 live births), 1990-2013, by country

  8. Maternal mortality ratio in Iran(2002 – 2011)

  9. Birth and maternal mortality in some Iranian universities(2007-20011)

  10. Birth and maternal mortality in Yazd(2002-2011) Birth (2002-2011) 222433 Maternal Death (2002-2011) 40 Maternal Mortality Ratio 17.9

  11. The most common causes of maternal death in 2011,Iran

  12. The most common causes of maternal death in Yazd, 2002-2011

  13. Percent of maternal deaths by place of birth, Iran

  14. Percent of maternal deaths by place of birth in Yazd,2002-2011

  15. Percent of maternal deaths by type of delivery, Iran

  16. Percent of maternal deaths by type of delivery in Yazd, 2002 - 2011

  17. Percent of delays leading to maternal death, Iran

  18. According to the results, it seems necessary considering the quality of services provided in the hospital emergency obstetric,92.5% of mothers had died in childbirth in hospitals(92.5% in Yazd & 94% in Iran). 55% of mothers had died giving birth by cesarean section in Yazd (63% in Iran). As of Huchon and Heyl study.Therefore reducing cesarean rates can also reduce maternal mortality.

  19. In most studies, the most common cause of maternal death is hemorrhage. Rajai and et al study was one of these cases,the hemorrhagy was reported by 34.1% as the most common cause of maternal mortality in Hormozgan. Hemorrhage is one of the reasons that are preventable. Improving care before,during and after delivery is effective in contrlling bleeding. And finally providing timely emergency obstetric will result in saving the lives of mothers(41% in 2011).

  20. Interventions to Reduce Maternal Mortality Historical Review • Traditional Birth Attendants-3 percent • Antenatal Care -11 percent • Risk Screening About 15 % Current Approach • Reduce Unwanted Fertility • Skilled Attendant at Delivery • Emergency Obst. Care Current Approach to Reduction of Maternal Mortality

  21. Risk Screening • Conclusion: Cannot identify those at risk of maternal mortality — Every pregnancy is at risk, if not proved, otherwise.

  22. Do women die immediately after developing complications in delivery? Average Complications to death interval • Hemorrhage PPH: 2 Hours ( 5.7 hrs*) APH: 12 Hours(11.5 hrs) • Ruptured uterus 1 Day • Eclampsia 2 Day (1.7 Days) • Obstructed Labour 3 Days • Infection 6 Days (2.4 Days) • (* Study in Maharashtra – Ganatra et al. WHO bulletin 1998, 76(6):591-598. Current Approach to Reduction of Maternal Mortality

  23. Current Approach to Reduction of Maternal Mortality

  24. Maternal Health Services • Good quality maternal health services are not universally available and accessible • > 39% receive no antenatal care • ~ 40% of deliveries unattended by skilled provider • ~ 60% receive no postpartum care during 1st 6 weeks following delivery • 15% unmet need of FP Current Approach to Reduction of Maternal Mortality

  25. Are there populations who are rich, well nourished and educated but have high maternal mortality? • Yes in USA there are such populations – eg. Faith Assembly of God who are rich, well nourished, and educated : their MMR was 872 in 1982 while in that year MMR in US general population was only 8 per 100,000 live births. • What is the key difference between these two groups? Use of modern obstetric care. Current Approach to Reduction of Maternal Mortality

  26. So All pregnant women need Access to* Emergency Obstetric Care (EmOC) * Not the same as Institutional Delivery [ID] Current Approach to Reduction of Maternal Mortality

  27. Thanks a lot Thanks a lot

  28. REFRANCE: Maine D. 1999. What's So Special about Maternal Mortality?, in Safe Motherhood Initiatives: Critical Issues. Berer M et al (eds). Blackwell Science Limited: London. World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a Technical Working Group. WHO: Geneva. Current Approach to Reduction of Maternal Mortality

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