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Maternal Mortality

Maternal Mortality. Max Brinsmead PhD FRANZCOG May 2011. Definition. The number of women who die from pregnancy-related or pregnancy-aggravated disease Up to 6 weeks postpartum Per 100,000 babies liveborn Ranges from 6500 in rural Afghanistan to Less than 10 in most of the developed world

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Maternal Mortality

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  1. Maternal Mortality Max Brinsmead PhD FRANZCOG May 2011

  2. Definition • The number of women who die from pregnancy-related or pregnancy-aggravated disease • Up to 6 weeks postpartum • Per 100,000 babies liveborn • Ranges from 6500 in rural Afghanistan to • Less than 10 in most of the developed world • Has risen from <400 in PNG to >600 • Was 141 at PMGH in 2010 (17 deaths) • Worldwide average is 400

  3. Maternal mortality should take into account... • The number of children a woman has • This will be reflected in the lifetime risk of pregnancy-related death • Worldwide average is 1:74 • Ranges from 1:6 in Sierra Leone to • 1:30,000 in Sweden

  4. Maternal Mortality at PMGH in 2010 • Haemorrhage • PPH (7 women) • With APH in two of these • One with acute uterine inversion • Infection (Sepsis and or septic shock) • In 7 women in total • Two with malaria • One with HIV • One with TB • Hypertensive Disease • In 3 women in total • One death associated with Caesarean section • One death due to Amniotic Fluid Embolism

  5. Aggravating Factors • Chronic anaemia • Malnutrition • Malaria • TB • HIV • Associated with up to 50% of maternal deaths in high prevalence areas • And has doubled MMR in many countries

  6. Reducing Maternal Mortality • General Measures • Reducing poverty • Better nutrition • More education • Improving the status of women • Improving access to health care • Appropriate healthcare staff and facilities • Antenatal care and screening for risk

  7. Reducing Maternal Mortality • Specific Measures • Blood transfusion • Antibiotics • Safe anaesthesia • Overcome legal and cultural barriers to abortion • FAMILY PLANNING • Using research and technology to improve maternity care

  8. Research and Technology 1 Postpartum Haemorrhage Causes 140,000 deaths worldwide Prevent by… Providing an oxytocic agent within 2 min birth Using controlled cord traction Uterine massage after placental delivery Treat with… Non pneumatic anti shock garment Intrauterine balloon tamponade

  9. Research and Technology 2 Puerperal sepsis Causes 80,000 deaths worldwide Prevent by… Hand hygiene Perineal hygiene Chlorhexidine vaginal douches intrapartum Treat with… Appropriate antibiotic by best route available

  10. Research and Technology 3 Unsafe Abortion Causes 68,000 deaths worldwide Prevent by… Better contraceptives Provide with… A combination of Mifepristone and Misoprostol Reusable and simple devices for suction curettage

  11. Research and Technology 4 Obstructed labour Causes 40,000 deaths per year worldwide And 73,000 women left with urinary fistula Detect by… Better training and use of Partographs Treat with… Ventouse and symphysiotomy Requires a robust and re useable instrument Safe and Simple Caesarean section

  12. Research and Technology 5 Preeclampsia and Eclampsia Complicates 5% of pregnancies Prevent by… Identification of at risk groups then aspirin + Ca supplements Detect by… Robust and reliable tests for proteinuria Treat with… Simple and acceptable protocols for MgSO4

  13. Maternal Mortality in Australia 1994-96

  14. Maternal Mortality in the Netherlands 1993-2005

  15. Indirect Causes of Maternal Mortality Australia

  16. Indirect Causes of Maternal Mortality The Netherlands

  17. Trends in Maternal Mortality

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