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Maternal Mortality

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Kunle Emmanuel
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Maternal Mortality

Unread post by Kunle Emmanuel » Thu Apr 11, 2019 10:38 am

]Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause related or aggravated by the pregnancy or its management and NOT due to any accidental or incidental cause.


Maternal Mortality Rate
Total number of female deaths due to complications of pregnancy, childbirth or within 42 days of delivery from puerperal causes in an area during a given year divided by total number of women of child bearing age (15-45 years).

Maternal Mortality Ratio
Total number of female deaths due to complications of pregnancy, childbirth or within 42 days of delivery from puerperal causes in an area during a given year divided by the total number of live births in the same area and year.

Risk Factors for Maternal Mortality
o Domestic Conditions
o Quality of Health Care
o Access to the Health Facility
o Physical, Economic, Social
o Availability of the Health Facility
o Manpower, working hours, physical
o Habits, Customs, Superstitions & other Cultural Patterns
o Nutritional Status of the mother
o Age of the mother
o Parity
o Repeated pregnancies
o Interval between two consecutive pregnancies
o Illiteracy
o Bad obstetric History
o Bad Medical History

Causes of Maternal Mortality
Direct Causes
o Hemorrhage
o Septicemia
o Toxemia( Eclampsia) of pregnancy
o Abortions
o Abnormalities of bony pelvis
o Ectopic Pregnancy
o Disproportion or malposition of fetus
o Improper management
o Poor technique in natal & postnatal periods.
Indirect Causes
o Anemia
o Infections & parasitic diseases
o Neoplasms
o Allergic, Endocrine, Metabolic , Nutritional Diseases
o Diseases of Blood
o Mental Disorder
o Disease of cardiovascular System
o Respiratory Disease
o Genito-urinary Diseases
o Disease of Bones & joints
o Chronic Poisoning

Prevention of Maternal Mortality
a) Pre – conception Guidance
b) Ante-natal / Pre-natal Care
c) Natal Care
d) Post-natal care
a) Pre-Conception Guidance
It means guiding women regarding her and her offspring care before she conceives.

Guidance includes:
o Avoid medications
o Take folic acid (400 mcg) daily for at least one month before you conceive
o Eat a healthy diet and exercise in moderation
o Obtain necessary vaccinations ( rubella & chicken pox) at least three months before conception
o Identify and remove health hazards in your home or workplace
o Achieve a healthy weight
o Discontinue cigarettes, alcohol and other drugs
o Test for infectious diseases and screen for other medical problems
o Genetic counseling


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Kunle Emmanuel
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Re: Maternal Mortality

Unread post by Kunle Emmanuel » Thu Apr 11, 2019 10:46 am

Antenatal /Prenatal Care

Antenatal care
It means the care of mother during pregnancy.
Antenatal care aims at prevention and detection of problems of pregnancy at an early stage to reduce maternal and perinatal morbidity and mortality.

Schedule of Antenatal Visits
Ideally, a pregnant woman should be examined every month until 7 months of pregnancy, fortnightly (after 2 weeks) for the next six weeks, and weekly after that, if everything is normal.
However, this is difficult to achieve so a minimum of 3 antenatal visits should be aimed at as shown below:
1st visit at 20th week or as soon as the pregnancy is known.
2nd visit at 32nd week
3rd visit at 36 week
Antenatal /Prenatal care involves:
1. Routine antenatal care
2. Specific health Protection
3. Maternal continuous monitoring
4. Continuous monitoring of fetal development
5. Mental Preparation
6. Family Planning
i. Routine antenatal care
o History
o Physical Examination i.e. Height, weight blood pressure pulse, abdominal examination, etc.
o Investigations i.e. complete Blood Picture, Urine R/E, Blood group and Rh Factor, Random Blood Sugar, Ultrasound
o Prescribe Medications i.e. iron , folic acid, calcium
o Counseling i.e. nutrition, avoiding drugs, radiation, rest,
o Immunization
o Reschedule Next visit

Schedule of Tetenus Toxoid (WHO)
o TT1: At first contact or as early as possible during pregnancy
o TT2: Four weeks after TT1
o TT3: Six months after TT2
o TT4: One year after TT3
o TT5: One year after TT4 or during next pregnancy

Risk Approach in Pregnancy
Central purpose of antenatal care is to identify ‘High Risk’ cases as early as possible and give skilled care to them:
High-Risk Pregnancies
o Women less than 18 or more than 35 years of age.
o Short statured women (less than 5 feet tall).
o Grandmultiparae, i.e. those who have had 5 or more previous deliveries.
o Women delivering less than 2 years after the last confinement.
o Women with multiple pregnancy such as twins or triplets.
o Women with a history of complication in previous pregnancy such as hypertension, eclampsia, premature labor, difficult delivery, cesarean section (even if followed by a vaginal delivery), antepartum or postpartum hemorrhage, stillbirth or neonatal deaths.
o Women with medical problems such as anemia, hypertension, heart disease, diabetes, etc.
o Women with a malpresentation such as breech, oblique or transverse lie.
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