Lecture on maternal and infant mortality

2021-03-22 12:00 AM

Complications of pregnancy and childbirth are the leading causes of death and serious health effects in women of childbearing age in developing countries.

Define

Maternal death is the death of a woman during pregnancy or within 42 days after the termination of pregnancy, regardless of the time and place of pregnancy, of any related cause or serious illness. up by the course of pregnancy or pregnancy management. The causes of maternal death, in this case, did not include accidental or unexpected causes "(World Health Organization 1990).

Maternal death

Maternal morbidity and mortality

Complications of pregnancy and childbirth are the leading causes of death and serious health effects in women of childbearing age in developing countries. World statistics show an estimated 529,000 women die each year from causes related to pregnancy. In addition, the number of cases of other women experiencing health effects such as genital damage, infection and disability during pregnancy or childbirth is 20 times higher than maternal mortality. This means that at least 10 million women each year are affected by reproductive health.

Women who have suffered from chronic malnutrition during development are at risk of having difficulty in labor. Anemia is also an indicator of the risk of bleeding and sepsis during childbirth and has been identified in at least 20% of maternal deaths in developing countries.

Maternal morbidity and mortality factors also affect the viability of the fetus and infant, leading to approximately 8 million neonatal deaths annually (about half of these are fetal deaths. ).

Table: Maternal mortality rates by region

Region

Mortality rate (per 100,000 live births)

Around the world

400

Africa

830

Asia

330

Europe

24

West Europe

17

Latin America

190

North America

8

Australia and New Zealand

6

In Viet Nam, the maternal mortality rate in 2000 was estimated at 130 deaths per 100,000 live births. This rate is especially high in remote and highland areas. The difference between regions of maternal mortality is also very high: the Central Highlands: 418 / 100,000, the Northern mountainous region 298 / 100,000, the Northern coastal region and the Mekong River Delta is 200 / 100,000. The main cause of death was five obstetric complications, led by postpartum haemorrhage (41%) and postpartum infection (20%).

Cause of maternal death

Direct cause:

Haemorrhage:

Prenatal haemorrhage occurs between the 28th and 40th weeks of pregnancy, possibly due to premature peeling of vegetables, forward vegetables ....

Hemorrhage during childbirth: often caused by uterine rupture and genital tract damage,  

Postpartum haemorrhage: usually occurs in the first hours of life. This is often the result of bleeding or damage to the genital tract.

Hemorrhage due to perforation of the uterus during abortion.      

Infection:

Usually leads to a serious illness causing death from sepsis.

Postpartum infection.

Infections after abortion.

Severe pre-eclampsia - eclampsia:

The patient can die in acute pulmonary edema, HELLP syndrome, eclampsia, postpartum haemorrhage ...

Table: Causes of maternal death.

Reason

Ratio (%)

Number of deaths / year

Haemorrhage

21

111.090

Abortion is not safe

14

74.060

Hypertension (eclampsia)

13

68.770

Chipped difficult

8

42.320

Sepsis

8

42.320

Gynecological complications

11

74.060

Indirect causes

25

132.250

Indirect causes:

The indirect cause of maternal death can be pre-existing and due to pregnancy should be more serious, accounting for about 15-20% of the death rate.

Examples: Heart disease and pregnancy, Basedow and pregnancy, diabetes and pregnancy, acute viral hepatitis, anemia, malaria, HIV / AIDS.

Maternal mortality rates in developing countries:

Before birth: 23.9%.

During birth: 15.5%.

After birth: 60.6%.

Infant mortality 

Worldwide, 7.3 million babies and newborns die each year in the last months of pregnancy, at birth, and within four weeks after birth, of which about 3.3 million children die at birth and 4 million infant deaths and another 4 million children die in the first year of life (WHO, 2005). The main cause is respiratory failure, infection, and malnutrition.

Factors affecting 

Factors affecting maternal mortality

Dan Tri: inadequate management of prenatal pregnancy; care before, during and after birth is not tight; Birth at home ...

Economy: Poor quality of life, poor nutrition

Local health network: Reproductive health counseling, unsafe abortion ...

Factors affecting infant mortality

Table: Effects of some maternal diseases on the newborn.

Mom is sick

Serious effects on the fetus and newborn

Severe anemia

Light weight, suffocating death when born

Haemorrhage

Asphyxiation, decreased blood flow, death after birth

Increased blood pressure during pregnancy

Light weight, suffocating death when born

Septicemia

Infection of the newborn

Chipped difficult

Suffocation, infant death, sepsis, injury, disability

Infection during pregnancy (STDs; HIV)

 Premature birth, neonatal eye infection, blindness, pneumonia. Immediately died at birth, infected with syphilis, transmitted HIV directly from mother to child

Hepatitis

Hepatitis

Fever

Low birth weight, premature birth, slow growth

Unplanned pregnant

Developing disease risk due to abuse of humiliation and disregard

Birth does not guarantee sterility

Infected babies, tetanus

Model 3 is slow

Delay in deciding to seek care (cultural factors / socioeconomic / educational attainment).

Delay in identifying and going to health facilities (ability to access medical facilities).

Delay in adequate and appropriate treatment (quality of care).

Remedies 

Strengthen management of prenatal pregnancies to propagate and educate pregnant mothers to be fully examined at least 3 times.

Strengthen care during childbirth, it is imperative to closely monitor pregnant women from labour to delivery. Take obstetrical sterility seriously.

Strengthening the contingent of specialized obstetricians - midwives at grassroots level Increase additional equipment.

Reduce unsafe abortion.

Empower women.

Reducing maternal mortality can be achieved by preventing unwanted pregnancy, preventing complications that occur during pregnancy, and by appropriately managing any complications that occur.

Skills development for midwives includes capacity building for primary management of obstetric complications and obstetric emergencies.

The emergency obstetric service must ensure the quality of clinical referral.

Provide adequate essential drugs and equipment.