Maternal & Perinatal Mortality By Dr Shaimaa Kadhim Al-Khafajy

Maternal death: Death of a woman while pregnant, or within 42 days of delivery, miscarriage, termination of pregnancy or ectopic, from any cause related to, or aggravated by the pregnancy or its management, but not from accidental or incidental cause. Direct death: The result of a complication of a pregnancy, delivery or puerperium, from intervention, incorrect treatment or from a chain of events resulting from any of the above.

Indirect death: Pregnancy related death in a patient with a preexisting or newly developed health problem that was not the result of direct obstetrical causes but which was aggravated by the physiological effects of pregnancy. Late death: Occurring between 42 days to 1 year, after miscarriage, abortion or delivery that is the result of direct or indirect cause. This is relevant in specific cases such as suicide which tend to occur after 42 days. Coincidental (fortuitous) death: From unrelated causes that happen to occur in the pregnancy or puerperium.

Maternal Mortality Ratio: Number of maternal deaths / 100.000 live births. Maternal Mortality Rate: Number of maternal deaths / 100.000 maternities. Maternities: Are the number of the pregnancies that result in a live birth at any gestation or still birth occurring at or after 24 completed weeks and required to be notified by law. Multiple gestation are counted only once.

There is a decline in the death rate because of: Antibiotics. Availability of blood and blood products. Use of oxytocic drugs, active management of the third stage. Better training of medical staff. Family planning, spacing, improved health service in general, and specially antenatal care. Legalization of abortion in some countries.

Causes of maternal mortality: Direct deaths: 1) Thrombosis and thromboembolic disease. 2) Hypertensive disease. 3) Amniotic fluid embolism. 4) Hemorrhage. 5) Infections and sepsis. 6) Genital tract trauma. 7) Early pregnancy deaths (ectopic, miscarriage). In developing world, hemorrhage, sepsis and hypertensive diseases are likely to be at the top.

B. Indirect deaths: Cardiac diseases. Neurological diseases. Respiratory diseases. Psychiatric disorders.

PERINATAL MORTALITY Stillbirth: Any fetus born with no signs of life after 23 weeks + 6 days. Early neonatal death: Death from birth to completed 6 days of life. Perinatal death: All stillbirths plus early neonatal deaths. Perinatal mortality rate: Is used to define the number of perinatal deaths per 1000 live births and stillbirths.

Late neonatal death: Death from age of 7 days to 27 completed days of life. Postneonatal death: Death at age of 28 days and over, but under 1 year. Infant death: Death at age under 1 year. Rates of neonatal and infant deaths are expressed as rates per 1000 live births. In England, the stillbirth rate is 5.4 per 1000 birth. The neonatal death rate is 4.1 per 1000 birth. Perinatal mortality rate is 8.7 per 1000 total births.

Causes of perinatal mortality: Prematurity (50%). Congenital malformations (16%). Antepartum fetal death. Birth asphyxia. Infection.

Thank You