Downloaded 267 times
More Related Content
Similar to Maternal mortality
Maternal mortality
- 1.
- 2. THE REALITY…. One woman dies every minute somewhere in the world because of a complication related to pregnancy or childbirth 80% of these death could be prevented
- 3. MATERNAL MORTALITY “Thedeath 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” - by FIGO
- 4. CLASSIFICATION Direct Deaths resulting from obstetric complications in pregnancy, labour and puerperium Indirect Deaths resulting from previous existing disease or diseases that developed during pregnancy and which was aggravated during pregnancy Fortuitous Deaths from other causes not related to or influenced by pregnancy Late Death after 6 weeks until 1 year after delivery
- 5. Classifiction Examples DirectThromboembolism Haemorrhage Ectopics Hypertensive disease of pregnancy Sepsis Amniotic fluid embolism Indirect Cardiac disease Suicide Epilepsy/CNS haemorrhage Infections Respiratory/gastrointestinal diseases
- 6. MMR (Maternal mortalityratio) Maternal mortality ratio (MMR) is the number of women who die during pregnancy and childbirth, per 100,000 live births. No of women dies 100,000 live births National MMR have reached a plateau between 28-30/100,000 LB the last 10 years
- 7. OUR STATE…. There is marked reduction in MMR in our state YEAR MMR ( per 100,000 live births) 2008 30.8 2009 26 2010 21.3 2011 21.7 2012 26.6 2013 9.3 (*** achieve MDG 5 target) 35 30 25 20 15 10 5 0 MMR 2008 2009 2010 2011 2012 2013 MMR
- 8. Causes of maternaldeath (malaysia)
- 9. 4 MAINCAUSES OF MATERNAL DEATH IN SARAWAK 1. Post partum haemorrhage 2. Pulmonary embolism 3. Eclampsia 4. Cardiac disease
- 10. Maternal death accordingto antenatal care
- 11. Phase of maternaldeath
- 13.
- 14. MDG 5A: IMPROVEMATERNAL HEALTH TARGET Reduce maternal mortality ratio by three quarters between 1990 and 2015 Indicators - Maternal mortality ratio - Proportion of birth attended by skilled health MDG 5 target for state by 2015 – 11.08/100,000 LB
- 15. MDG 5B- IMPROVEMATERNAL HEALTH TARGET Universal access to reproductive health by 2015 Indicators - Contraceptive prevalence rate - Adolescent birth rate - Antenatal care coverage - Unmet need for family planning
- 17.
- 18. HIGH RISK GROUPS Remote communities Illegal immigrants High risk pregnancies ** SPECIAL ATTENTION ** CLOSE MONITORING
- 19. DEFICIENCIES NOTED FROMSTATE CEMD Directives & guidelines not followed Lack of blood & blood products in DH Substandard management of PPH at DH Delays in transferring ill patients to specialist hospitals Obstetric patients only seen by MA in A&E or OPD Unsafe clinical practices in LW Inadequate post natal care Failure to offer TOP in early pregnancy by physicians and cardiologists More specialists & specialist hospitals!
- 20. Lessons from NationalCEMD More than 60% of maternal deaths occurred during the postnatal period The risk of maternal deaths higher in women over 40 yrs and in mothers who already had 6 or more children Deaths due to obstetric embolism is rising Unbooked cases have higher risk of mortality Home deliveries is unsafe
- 21. WHAT SHOULD WEDO???
- 22. Plan of Action:1 Hospital Directors should address individual hospital needs in terms of manpower and O&G medical equipment and ambulances Monitoring & resuscitative equipments are old and lacking JKN to highlight & forward asset request to MOH To make carboprost (haemabate), intrauterine balloon (Bakri balloon) & magnesium sulphate available in all DH and health centers that conducts deliveries Need for equipped ambulance and transport for ‘home visiting’
- 23. Plan of Action:2 All previous and future directives from JKNS and O&G guidelines MUST be implemented and practiced Staff should be briefed Should be kept in a file and made easily accessible in LW and A&E/OPD for reference Perhaps LW nursing sister can be assigned?
- 24. Plan of Action:3 All antenatal and postnatal mothers should be considered as HIGH RISK when attending OPD/A&E and MUST reviewed by a medical officer Low tolerance for admission All repeat A&E visits for the same complaints should be admitted for further monitoring and management
- 25. Plan of Action:4 Ensuring the level of blood and FFP in every hospital is always at optimal level Yellow alert should be at 70% optimum stock Red alert should be at 50% optimum stock Increase FFP stock by 20% if possible A laboratory staff should be assigned to be in charge Stock level should be checked daily
- 26. Plan of Action:5 Improving the management of PPH in district hospitals: 1. Compulsory regular obstetric drills (3x/year) 2. ‘Red Alert’ system to be implemented 3. PPH box to be made available and regularly checked 4. Carboprost at least 4 ampoules must be made available in LW 5. BAKRI balloons once used have to be indented 6. ‘PPH management flowchart’ have to be on the notice board 7. Ambulance driver should called once Red Alert is activated
- 27. Plan of Action:6 Reduce delays in transferring ill obstetric patients Refer to specialist early! Utilise the BUDDY SPECIALIST system Discuss various scenarios and decide best way to reduce transit time All hospital directors to be well versed with SOP on using medevac services
- 28. Plan of Action:7 Improve O&G clinical services at the district hospital level through: 1. CME activities (monthly) 2. Clinical audit of near misses and bad outcome (monthly) 3. ‘Buddy Specialist’ to do supervisory visits (6 monthly) 4. Regular drills for obstetric emergencies
- 29. Plan of Action8 Start Pre-pregnancy care & family planning services in all hospitals in 2011 (MDG 5) Counseling for family planning for all postnatal patients compulsory IUCD should be made an acceptable alternative to BTL, particularly in specialist hospitals where the waiting list for BTL is longer than 6 months ‘High risk patients’ needs to be identified and managed accordingly (inc. postnatal BTL)
- 30. Plan of Action9 Audit Audit activities for all ‘near misses’ & complications should be carried out on weekly basis The only way to identify weaknesses and to improve services Feedback on audit activities by each hospital should be made compulsory