Maternal morbidity and mortality

Role of nurse in midwifery and obstetrical care

1. MATERNAL MORBIDITY AND MORTALITY Presented by, Abiya mary biju 3 rd year bsc (n) Yashoda laxmi college of nursing

2. MATERNAL MORTALITY : DEFINITION : Maternal mortality is defined as the death of a woman who is pregnant or within 42 days of termination of pregnancy, irrespective of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy and its management.

3. Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy , Irrespective of the duration and site of pregnancy, From any cause related to or aggravated by the pregnancy or its management, But not from accidental or incidental issues .

4. CLASSIFICATION OF MATERNAL DEATH

5. Classification : Direct Deaths resulting from obstetric complications in pregnancy, labour and puerperium . Indirect Deaths resulting from previous existing disease or disease that developed during pregnancy and which was aggravated during pregnancy. Fortuitous Deaths from other causes not related to or influenced by pregnancy.

6. Direct obstetric deaths ; The deaths resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium ), from interventions, omissions, or incorrect treatment, or from a chain of events resulting from any of the above are called direct obstetric deaths . Indirect obstetrical deaths Those resulting from previous existing disease or disease that developed during pregnancy and that was not due to direct obstetric causes but aggravated by the physiological effects of pregnancy.

7. LATE MATERNAL DEATH It is the death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year, after termination of pregnancy. PREGNANCY RELATED DEATH It is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.

8. MATERNAL MORTALITY RATE FORMULA

9. CAUSES OF MATERNAL MORTALITY

10. OBSTETRICAL CAUSES Toxaemias of pregnancy Haemorrhage Infections Obstructed labour Unsafe abortions

11. Non obstetric causes Anaemia Associated diseases e.g., cardiac, renal, hepatic, metabolic, infectious malignancies and accidents.

12. Social causes Age at child birth Parity Too close pregnancies Family size Malnutrition Poverty Illiteracy Ignorance

13. Contd ….. Prejudices Lack of maternity services Shortage of health manpower Delivery by untrained dais Poor environmental sanitation Poor communications and transport facilities Social customs

14. PREVENTIVE AND SOCIAL MEASURES

15. Early registration of pregnancy. Atleast three antenatal check-ups. Dietary supplementation, including correction of anemia. Prevention of infection and haemorrhage during puerperium . Prevention of complications, e.g., eclampsia , malpresentations , ruptured uterus etc. Treatment for medical conditions - e.g., hypertension, diabetes, tuberculosis, etc. Prophylaxis.

16. Contd … 8. Trained local dais and female health workers. 9. Institutional deliveries for women with bad obstetrical history and risk factors. 10. Promotion of family planning – to control the number of children to not more than two and spacing of births. 11. Identification of every maternal death and searching for its cause.

17. PERINATAL MORTALITY AND MORBIDITY RATES

18. PERINATAL MORBIDITY Perinatal morbidity and mortality are primarily the result of poor placental perfusion or preterm delivery. Perinatal morbidity implies to the illness of the neonate from birth to first four weeks of life. It results mainly due to birth trauma, asphyxia, prematurity and congenital malformations.

19. PERINATAL MORTALITY Perinatal mortality ratio : Fetal and early neonatal deaths x 1000 total live birth - The  World Health Organization  defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 total births, that  22 completed weeks (154 days)  of gestation, and ends seven completed days after birth“.

20. ROLE OF NURSE IN MIDWIFERY AND OBSTETRICAL CARE

21. ANTENATAL PERIOD Health history, obstetrical history and physical examination. Antenatal visits are done by a midwife. Abdominal examination and record is kept for further visits. Educating mothers. Identification of high risk mothers and referral services. Training of students at different levels, and supervision of co-workers.

22. INTRANATAL PERIOD Observing the mother. Abdominal and vaginal examination. Maintaining partograph . Psychological support and supportive care. Delivery of child.

23. POSTNATAL PERIOD Postpartum supervision and care. To detect any health problems of the mother and baby. Encourage breastfeeding. Measures to prevent any complications. Family planning instructions. Health education to mother .

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