CAUSES OF MATERNAL MORTALITY

THE CAUSES ARE DIVERSE BUT CAN BE DIVIDED INTO TWO BROAD HEADS: 1. DIRECT CAUSES (80%)
This includes the Obstetric complications of pregnancy, labour & puerperium and faulty treatment / management

2. INDIRECT CAUSES (20%)

This includes pre-existing diseases which are worsened during pregnancy and the diseases developing during pregnancy but not due to obstetric reasons

PERCENTAGE OF WORLDWIDE MATERNAL MORTALITY ACCORDING TO CAUSES

INDIRECT CAUSES 20% SEVERE BLEEDING 24%

OTHER DIRECT CAUSES 8%

UNSAFE ABORTION 13% OBSTRUCTED LABOUR 8% ECLAMPSIA 12%

INFECTIONS 15%

IT HAS BEEN OBSERVED THAT IN INDIA THE CAUSES OF MATERNAL MORTALITY ARE DIFFERENT FROM THOSE IN THE DEVELOPED WORLD

PERCENTAGE OF MATERNAL MORTALITY IN INDIA ACCORDING TO CAUSES

OTHER CAUSES 34%

UNSAFE ABORTION 8% OBSTRUCTED LABOUR 5%

HYPERTENSIVE DISORBERS 5%

SEPSIS 11%

HAEMORRHAGE 37%

DISCUSSION OF THE CAUSES

PREGNANCY AND RELATED EVENTS ARE ALWAYS ASSOCIATED WITH SOME HEALTH RISKS BUT THIS IS NOT THE REASON FOR NOT BEING ABLE TO BRING DOWN MATERNAL MORTALITY IN FACT MOST OF THE CAUSES OF MATERNAL DEATHS ARE EASILY PREVENTABLE THE MEDICAL COMPLICATIONS ARE IMPORTANT BUT WE WILL FIRST DISCUSS THE NON-MEDICAL CAUSES IN BRIEF THESE REFLECT THE PREDISPOSING FACTORS FOR MOST OF THE MEDICAL REASONS

FAMILIAL, SOCIAL, ECONOMICAL AND STATE-RELATED FACTORS

TOO EARLY, TOO MANY and TOO CLOSE PREGNANCIES SHOULD BE AVOIDED

AGE OF THE MOTHER

It is well known that the safest age group for child bearing is 20-30 yrs. Ages at both the extremes are at risk for various complications.

FAMILY PLANNING (Number & spacing of children)

The mother as well as the family members should be advised to limit family size to 2 children and to have ample gap (ideally 3 yrs.) between successive pregnancies

FAMILIAL, SOCIAL, ECONOMICAL AND STATE-RELATED FACTORS

CONTD.

UNHEALTHY ABORTIONS:
Lack of information on Family Planning and Contraceptive methods is a major reason for the

significant number of abortions opted for in our country a high percentage of which is done by untrained personnel and / or at places without proper facilities. Thus Medical Termination of pregnancy often leads to such complications so as to contribute to Maternal Mortality

FAMILIAL, SOCIAL, ECONOMICAL AND STATE-RELATED FACTORS

Illiteracy, Ignorance and Lack of Awareness
CONTD.

Many of the pregnant women are completely ignorant about various aspects of pregnancy, having no idea about the DANGER SIGNS. They realize the need of seeking medical help often too late. The Illiterate are unable to understand the informative posters / signboards that the Government puts up for their knowledge and benefit. Often the pregnant women are unaware of the presence of an Ante-Natal Clinic in their locality. Even if a pregnant woman attends Ante-Natal Clinic she is unlikely to understand and follow all the directions given.

FAMILIAL, SOCIAL, ECONOMICAL AND STATE-RELATED FACTORS

Table showing the Accessibility of to Pregnant Women Ante-Natal Care
CONTD.

INDICATORS
ANY VISIT TO ANTE-NATAL CLINIC THREE OR MORE VISITS INSTITUTIONAL DELIVERIES SAFE DELIVERIES
(Institutional Deliveries + Deliveries conducted at home by trained Dais)

OBSERVATIONS OF DISTRICT LEVEL HOUSEHOLD SURVEY(DLHS) of 2002-03 74.0 % 44.5 % 39.8 % 54.0 %

TETANUS TOXOID (Total dose)

79.7 %

FAMILIAL, SOCIAL, ECONOMICAL AND STATE-RELATED FACTORS

CONTD.

APART FROM ALL THE ABOVE MENTIONED POINTS THERE IS ACCESSIBILITY OF FIRST REFERRAL UNITS Fastest available mode of conveyance is a must to carry a mother to the nearest FRU in case of any emergency. This is especially necessary in case of Haemorrhagic Crises. In such cases time gap between onset of bleeding and DEATH is very less. Delay in bringing a mother to FRU is a major reason of the high Maternal Mortality due to Haemorrhage.

CLINICAL CAUSES OF MATERNAL MORTALITY

DIRECT

CAUSES

HAEMORRHAGE
TOXAEMIAS OF PREGNANCY OBSTRUCTED LABOUR INFECTIONS UNSAFE ABORTIONS

INDIRECT

CAUSES

ANAEMIA
CARDIAC / RENAL / HEPATIC DISORDERS INFECTIONS MALIGNANCIES