1
Forth stage
Obstetric
Lec-5
د . براء
1/1/2014
Vital statistics in obstetrics
:
Objectives
At the end of this lecture, the student should:
Know the definitions of maternal mortality, its subdivisions and its leading causes.
Know the definitions of the perinatal mortality rate and its subdivisions.
Have knowledge of the way in which perinatal deaths are classified and the leading causes.
Recognize that reducing perinatal mortality requires practical obstetric skills.
maternal mortality :
Definitions:
Maternal death: death of a woman while pregnant, or within 42 days of termination of
pregnancy, from any cause related to, or aggravated by, the pregnancy or its management,
but not from accidental or incidental causes.
Maternal death :
Direct
Indirect
Coincidental (Fortuitous)
Direct deaths: resulting from obstetric complications of the pregnant state (pregnancy,
labour and puerperium) , from interventions, omissions, incorrect treatment or from a
chain of events resulting from any of the above (e.g. death from major postpartum
haemorrhage in a previously well woman).
Indirect deaths: resulting from previous existing disease, or disease that developed during
pregnancy and was not due to direct obstetric causes, but was aggravated by the
physiologic effects of pregnancy (e.g. death from a cardiac lesion).
Late deaths: occurring between 42 days and 1 year after abortion, miscarriage or delivery
that are due to direct or indirect maternal causes.
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Coincidental (fortuitous) deaths: from unrelated causes that happen to occur in pregnancy
or the puerperium (e.g. road traffic accident).
MATERNAL MORTALITY RATE:
This is expressed in the UK as the number of maternal deaths (MD) per 100 000
maternities. ( A maternity is a clinical pregnancy ending in live birth, stillbirth, miscarriage
or abortion).
The WHO, however, defines the maternal mortality rate as the number of maternal deaths
per 100 000 women of reproductive age.
Maternal mortality ratio: the number of maternal death per 100,000 live births. It reflects
the woman’s basic health status, her access to health care, and the quality of service that
she receives.
Every year approximately 200 million women become pregnant in developing countries-
more than 500,000 will die of pregnancy related causes.
Causes of direct and indirect maternal deaths:
Direct deaths:
1. Thrombosis and thromboembolism
2. Hypertensive disease
3. Haemorrhage
4. Sepsis
5. Amniotic fluid embolism
6. Ectopic pregnancy
7. Spontaneous miscarriage
8. Legal termination
9. Genital tract trauma
10. Anaesthesia
11. Fatty liver
Indirect deaths:
1. Cardiac disease
2. Psychiatric disorder
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3. Other indirect causes
4. Indirect malignancies
Maternal mortality rate is improved because:
1. Improvement of the general health of the population.
2. Improvement of the nutrition.
3. Better obstetric training.
4. Increase the use of blood transfusion.
5. Use of antibiotics.
Perinatal mortality
Definitions:
Stillbirth: any fetus born with no signs of life after 24 weeks of gestation.
Of particular importance in the definition is that it is delivery of the baby which dates the
stillbirth and not the point in the pregnancy at which the baby was known to die.
Early neonatal death: death in the first week after birth.
END = death in the 1
st
week of life ×1000
live births
Perinatal death: all stillbirth plus death in the first week after birth.
Perinatal mortality rate (PMR): the number of stillbirths and early neonatal deaths per
1000 live births and stillbirths.
PMR = END + stillbirth ×1000
Total birth
The PMR is widely used as an indicator of the quality of obstetric care and enables
comparisons to be made among nations, regions and indeed individual hospitals.
Late fetal loss: deaths occurring between 20+0 weeks and 23 weeks+6 days. If gestation is
not sure, all birth of at least 300g are reported.
Late neonatal death: death of a neonate from age 7 days to 27 completed days of life.
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Post neonatal death: death of a baby at age 28 days and over, but under 1 year.
Infant death: death at age under 1 year but born alive.
Infant deaths therefore include early and late neonatal death and post-neonatal death .
Rates of neonatal and infant death are expressed as rates per 1000 live births
(while late fetal loss rate, stillbirths rate and PMR is per 1000 live and stillbirth)
Classification of Perinatal mortality causes :
Fetal abnormality
Preterm delivery
Intrauterine growth retardation
Unexplained intrauterine death
Antepartum haemorrhage
Maternal hypertension
Intrapartum asphyxia
Infection
Trauma
Hemolytic disease