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Maternal Mortality

Dr. Saurabh Kumar Assistant Professor Community Medicine FMMC, Mangalore

Maternal Mortality
Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the site and duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from incidental or accidental causes.

Statistical Measures of Maternal Mortality

Maternal Mortality Ratio Maternal Mortality Rate Adult lifetime risk of maternal death ICD classification

Maternal mortality ratio

India : 1938 20/1000LB 1997 - 407/1,00,000 LB 2007-09 212/1,00,000 LB Karnataka -178 per 1,00,000 LB

Approaches for measuring MMR

Civil registration system Household surveys Sisterhood methods RAMOS Verbal autopsy Census

Maternal mortality
Causes Hemorrhage 38 % Sepsis 11 % Hypertension- 8% Obstructed labour 15% Others 34% anaemia, illegal abortions

Determinants of maternal mortality

Medical causes
Obstetric Causes PIH Hemorrhage Infection Obstructed labour

Social causes
Age Parity Spacing Family size Malnutrition Poverty Illiteracy Customs, taboos Lack of services

Determinants of maternal mortality

Non obstetric causes Anaemia Associated diseases Malignancy Accidents Shortage of health manpower, TTBAs Poor environmental sanitation Poor communications & transport facility

Strategies to reduce MMR

Essential Obstetric Care Emergency Obstetric Care Janani Suraksha Yojana Training of MBBS doctors Vandematram scheme

Antenatal Care Visits

Cleans of Delivery
Clean hands Clean surface Clean cord tie Clean blade Clean cord stump Clean towel Clean water

Post natal care

Essential obstetric care in RCH-I

Early registration of pregnancy Provision of minimum 4 antenatal checks up by ANM or medical officer Promotion of institution delivery and provision of safe delivery at home Provision of postnatal care

Other approaches in RCH-I

Provision of additional nursing staff Promotion of 24 hours delivery services at PHCs/CHCs Assistance with referral transport Trained birth attendant(TBA) training RCH camps

Basic Emergency Obstetric Care

Parenteral antibiotics Parenteral oxytocic drugs Parenteral anticonvulsants Manual removal of retained products Assisted vaginal delivery

Comprehensive emergency obstetric care

Basic emergency Obstetric care services: plus Anaesthetic services Surgical services(C-section) Safe blood transfusion services

Training in Anaesthesia
Training of MBBS Doctors in Life Saving Anaesthetic Skills for Emergency Obstetric Care. 18 weeks training course The First Training Programme Conducted at AIIMS for Chhattisgarh Training to be conducted in phases and limited to the requirement at FRUs.

Training in Obstetric Management

Training of MBBS doctors in obstetric management and skills including C.S. in RCH-II Training to be conducted in collaboration with FOGSI Duration of training to be 16 weeks Expert Group is considering other details

Blood Storage Facility

Management of obstetric emergencies is sometimes not possible due to nonavailability of blood. The Drugs and Cosmetics Act was therefore modified to facilitate establishment of blood storage centres at FRUs.

Janani Surkasha Yojna

To promote Institutional Deliveries To reduce overall Maternal Mortality Ratio Infant Mortality Rate 100 % centrally sponsored Integrates cash assistance with delivery & post-delivery care.

Vandematram Scheme
It is a voluntary scheme wherein any obstetric and gynaec specialist, maternity home can volunteer Enrolled doctors will display vandemataram logo at their clinics. Iron and folic acid tablets, oral pills, TT injections, etc will be provided for free distribution.

Madilu Scheme
Pregnant women (BPL) who visited government hospitals and delivered children were entitled to get Rs 825 worth Post natal care kit free of cost.

Prasuti Araike
Financial assistance of Rs.2000/during Antenatal period for BPL women. Split into two installments given during 2nd and 3rd trimester.

Thai Bhagya
Bidar, Gulbarga, Raichur, Koppal, Bijapur, Bellary, Bagalkote Chamrajnagar