Max Brinsmead MB BS PhDMay 2015

Maternal Mortality

Definition

The number of women who die from pregnancy-related or pregnancy-aggravated diseaseUp to 6 weeks postpartum

Per 100,000 babies livebornRanges from 6500 in rural Afghanistan to

Less than 10 in most of the developed worldHas risen from <400 in PNG to >600Was 141 at PMGH in 2010 (17 deaths)Worldwide average is 400

Maternal mortality should take into account...

The number of children a woman hasThis will be reflected in the lifetime risk

of pregnancy-related deathWorldwide average is 1:74Ranges from 1:6 in Sierra Leone to1:30,000 in Sweden

Maternal Mortality at PMGH in 2010Haemorrhage

PPH (7 women)With APH in two of theseOne with acute uterine inversion

Infection (Sepsis and or septic shock)In 7 women in total

Two with malariaOne with HIVOne with TB

Hypertensive DiseaseIn 3 women in total

One death associated with Caesarean section

One death due to Amniotic Fluid Embolism

Aggravating Factors

Chronic anaemiaMalnutritionMalariaTBHIV

Associated with up to 50% of maternal deaths in high prevalence areas

And has doubled MMR in many countries

Reducing Maternal Mortality

General MeasuresReducing povertyBetter nutritionMore educationImproving the status of womenImproving access to health careAppropriate healthcare staff and

facilitiesAntenatal care and screening for risk

Reducing Maternal MortalitySpecific Measures

Blood transfusionAntibioticsSafe anaesthesiaOvercome legal and cultural barriers to

abortionFAMILY PLANNINGUsing research and technology to improve

maternity care

Research and Technology 1

Postpartum HaemorrhageCauses 140,000 deaths worldwide

Prevent by…Providing an oxytocic agent within 2

min birthUsing controlled cord tractionUterine massage after placental

deliveryTreat with…

Non pneumatic anti shock garmentIntrauterine balloon tamponade

Research and Technology 2

Puerperal sepsisCauses 80,000 deaths worldwide

Prevent by…Hand hygienePerineal hygieneChlorhexidine vaginal douches

intrapartumTreat with…

Appropriate antibiotic by best route available

Research and Technology 3

Unsafe AbortionCauses 68,000 deaths worldwide

Prevent by…Better contraceptives

Provide with…A combination of Mifepristone and

MisoprostolReusable and simple devices for

suction curettage

Research and Technology 4Obstructed labour

Causes 40,000 deaths per year worldwideAnd 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 instrumentSafe and Simple Caesarean section

Research and Technology 5

Preeclampsia and EclampsiaComplicates 5% of pregnancies

Prevent by…Identification of at risk groups then aspirin +

Ca supplementsDetect by…

Robust and reliable tests for proteinuriaTreat with…

Simple and acceptable protocols for MgSO4

Maternal Mortality in Australia 1994-96

Maternal Mortality in the Netherlands 1993-2005

Indirect Causes of Maternal Mortality Australia

Indirect Causes of Maternal Mortality The Netherlands

Trends in Maternal Mortality