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Every Pregnancy Is at Risk: Current Approach to Reduction of Maternal and Neonatal Mortality By;Mignot Anley (DMRHospital)
Federal Democratic Republic of Ethiopia Ministry of Health
Session Objectives
Definitions
Maternal Mortality = is defined as 'the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Can be Direct or Indirect Maternal Deaths
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Definitions; contd..
Define:
99% in developing world ~ 1% in developed countries Many millions more suffer complications e.g. obstetric fistulae, secondary infertility
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Globally, the total number of maternal deaths decreased from 543 000 in 1990 to 287 000 in 2010. Likewise, the global maternal mortality ratio (MMR) declined from 400 maternal deaths per 100 000 live births in 1990 to 210 in 2010
Of every day...
380 women become pregnant 190 women face unplanned or unwanted pregnancy 110 women experience a pregnancy related complication 40 women have an unsafe abortion 1 woman dies every two minutes from a pregnancyrelated complication
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*Nearly all (99%) abortion deaths are due to unsafe abortion. **This category includes deaths due to obstructed labor or anaemia. Other direct causes include embolism, ectopic pregnancy, anesthesia-related. Indirect causes include: malaria, heart disease.
Source: WHO 2010. BEmONC LRP: Ethiopia Best Practices in Maternal and Newborn
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Out of estimated 2,924,225 pregnancies in 2003E.C, only 16.6% attended by a skilled health provider. (Health and Health Related Indicators
EFY,2003)
Maternal mortality ratio decreased from 871/100 000 live births in 2011 to 676/100 000 live births in 2011 (DHS-2011), Our country is one of the six countries in 2008 which contribute more than 50% of all maternal deaths. (THE LANCET on 12 April 2010)
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Newborn health and survival are closely linked to care the mother receives before and during pregnancy, childbirth, and the postnatal period.
Every year:
4 million neonatal deaths (first month of life) 4 million stillbirths Eight neonatal deaths every minute
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Neonatal mortality is 37 per1,000 live births (DHS 2011). 50 percent of infant deaths in Ethiopia occur during the first month of life. One in every 17 Ethiopian children dies before reaching age one,
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Lack of understanding of complications Acceptance of maternal and newborn death Low status of women Socio-cultural barriers to seeking care
Mountains, islands, rivers poor organization Lack of transport Lack of triage system Lack of supplies, personnel Poorly trained personnel; poor attitudes
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Ask group: What are some interventions that have not proved successful in reducing mortality?
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Risk screening
Current Approach
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Most maternal deaths occur during labour, delivery or the first 24 hours postpartum When problems are managed in a timely and effective manner, mothers and babies lives are saved
Providers and the facility must be prepared to address emergencies at all times 80% of maternal deaths are preventable by BEmONC LRP: Ethiopia Current Approach to Reduction of appropriate treatment 25
Antenatal care clinics started in US, Australia, Scotland between 19101915 New concept - screening healthy women for signs of disease By 1930s large number (1200) ANC clinics opened in UK No reduction in maternal mortality Is ANC important? YES!! Focused, individualized care leads to early detection of problems and birth preparation
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What are the key interventions to reduce maternal and neonatal mortality?
Access to family planning, Skilled attendants during pregnancy and childbirth Access to emergency obstetric and newborn care (EmONC),
Effective referral system Fully functioning health services 24/7
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Comprehensive EmONC
Perform EmOC Signal functions 1-7, plus: 8) Perform surgery (e.g. cesarean delivery)
4) Perform manual removal of placenta 10) Provision of emergency obstetric anaesthesia 5) Perform removal of retained products (e.g. MVA) 6) Perform assisted vaginal delivery (e.g. vacuum extraction) 7) Perform neonatal resuscitation (e.g. with bag and mask)
BEmONC LRP: Ethiopia Best Practices in Maternal and Newborn
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Antenatal care
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The higher the proportion of deliveries attended by skilled provider, the lower the countrys maternal mortality ratio
Maternal deaths per 1000000 live births
y = -578.45ln(x) + 2761.10 R = 0.74
Y Log. (Y)
For years, much of basic and emergency obstetric and newborn care was provided according to tradition and routine practice rather than according to evidence. To be effective, care should be evidence-based. We have better understanding of emergency obstetric care (EmOC) and best practices in labour and delivery and Enhanced appreciation of the role that community mobilization, birth preparedness, and a continuum of care make
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Obstructed Labor 4%
Hemorrhage 34%
Source: WHO Analysis of causes of maternal deaths: A systematic review. The Lancet, Vol 367, April 1, 2006.
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Clean facilities Women friendly care kindness, respect, information Availability of drugs and medical equipment Culturally appropriate services
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Summary
Skilled attendant at childbirth is one of the most effective interventions to prevent maternal and perinatal mortality and morbidity
BEmONC LRP: Ethiopia Best Practices in Maternal and Newborn
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References
Maine D. 1999. What's So Special about Maternal Mortality?, in Safe Motherhood Initiatives: Critical Issues. Berer M et al (eds). Blackwell Science Limited: London. Lancet Maternal Survival Series, September 28, 2006 at www.thelancet.com World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a Technical Working Group. WHO: Geneva. WHO Analysis of causes of maternal deaths: A systematic review. The Lancet, vol 367, April 1, 2006.
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