Obstetrics Simplified - Diaa M. EI-Mowafi
Maternal Mortality
Maternal Mortality Rate (MMR)
The number of maternal deaths per 100.000 live births which is related to pregnancy, labour or puerperium.
Incidence: 1:100.000 in UK.
Classification
- Direct obstetric deaths: resulting from obstetric complications of pregnancy, labour or puerperium and from interventions, omissions and/or incorrect treatment e.g. rupture uterus.
- Indirect obstetric deaths: resulting from previously existing disease or a disease that developed during pregnancy, labour or puerperium e.g. cardiac diseases.
- Accidental deaths: not related to pregnancy, labour or puerperium itself but happened during it e.g. automobile accident.
Only direct and indirect obstetric deaths constitute the maternal mortality rate.
Risk Factors
- Maternal age: The golden age for fertility and childbearing is between 18 and 35 years, the risk is more both to the mother and foetus with more deviation below or above this range.
- Parity: The risk is more in primigravidae and grand multiparae (5 or more).
- Bad obstetric history as difficult labour ended by stillbirth or neonatal death.
- History of previous uterine surgery e.g. C.S or hysterotomy.
- History of medical disorders e.g. cardiac disease and hypertension.
- Malpresentations and malpositions.
- Multiple pregnancy.
- Antepartum haemorrhage.
- Neglected antenatal care.
- Socio-economic standard: MMR is higher in low standard society, distant areas and developing countries.
Causes
- Haemorrhage which may be due to:
- Abortion.
- Ectopic pregnancy.
- Gestational trophoblastic diseases.
- Antepartum haemorrhage.
- Postpartum haemorrhage.
- Infection as in:
- Septic abortion.
- Chorioamnionitis.
- Puerperal sepsis.
- Medical disorders as:
- Hypertensive disorders with pregnancy.
- Diabetes mellitus.
- Cardiac diseases.
- Renal disorders.
- Thrombo-embolic disorders.
- Amniotic fluid embolism.
- Surgical disorders as:
- Uterine rupture.
- Anaesthetic complications as:
- Pulmonary collapse.
- Mendelson’s syndrome.
Prevention
- Proper antenatal care (see antenatal care).
- Proper intranatal care:
- Hospital delivery is safer.
- Well equipped delivery room.
- Availability of blood transfusion.
- Available anaesthetist.
- Replacement of general by regional anaesthesia whenever possible.
- Nothing by mouth in the first stage except sips of water and antacid.
- Aseptic and antiseptic measures.
- Senior experienced obstetrician to manage complicated cases.
- Proper intranatal monitoring by clinical observation, cardiotocography and partogram.
- Proper postnatal care:
- Observation for:
- Pulse.
- Temperature.
- Blood pressure.
- Vaginal bleeding.
- Uterine tone and fundal level.
- Level of maternal consciousness.
- Aseptic and antiseptic measures.
- Observation for:
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