Maternal Mortality: Causes and Prevention

Definition & Scope - Grim Numbers Game

• Maternal Death (WHO): Death of a woman while pregnant or within 42 days of pregnancy termination, from any cause related to or aggravated by the pregnancy or its management (excluding accidental/incidental causes).
• Maternal Mortality Ratio (MMR):
  • Number of maternal deaths per 100,000 live births in a given period.
  • Formula: $(Number of maternal deaths / Number of live births) \times 100,000$
  • Key indicator of quality of obstetric care.
• Maternal Mortality Rate (MMRate):
  • Number of maternal deaths per 100,000 women of reproductive age (15-49 years) in a given period.
  • Indicates risk of maternal death among women of reproductive age.
• Lifetime Risk of Maternal Death: Probability that a 15-year-old girl will die from a maternal cause during her reproductive life.
• Current Indian MMR: 97 per 100,000 live births (SRS 2018-20).
• SDG Target 3.1: Reduce global MMR to < 70 per 100,000 live births by 2030.

⭐ India shows significant progress: MMR ↓ from 103 (SRS 2017-19) to 97 (SRS 2018-20) per 100,000 live births.

Causes - Why Mothers Die

Direct Causes (Majority of deaths): 📌 Mnemonic: HORSE-A

• Hemorrhage: Leading cause.
  • Postpartum Hemorrhage (PPH) is the most common type. Antepartum Hemorrhage (APH) also contributes.
• Obstructed Labour
• Ruptured Uterus (Rt)
• Sepsis (Puerperal sepsis)
• Eclampsia & other Hypertensive Disorders of Pregnancy (e.g., Pre-eclampsia)
• Abortion complications (esp. from unsafe abortions)

Indirect Causes (Contribute significantly):

• Anemia (Severe)
• Malaria
• Cardiac Diseases (pre-existing or pregnancy-induced)
• Hepatitis (Viral)
• Other pre-existing medical conditions (e.g., Diabetes, HIV)

The Three Delays Model: This critical model identifies three phases where delays can occur, preventing timely and effective maternal healthcare, ultimately leading to increased risk of mortality.

⭐ Postpartum Hemorrhage (PPH) is the single largest cause of maternal deaths in India, accounting for approximately 38% of all maternal deaths.

Prevention Strategies - Shielding Mothers

• Antenatal Care (ANC):
  • Minimum 4 comprehensive antenatal visits (WHO).
  • TT: 2 doses/booster per schedule.
  • Iron-Folic Acid (IFA) supplementation: at least 100 tablets (60mg elemental iron and 500mcg folic acid).
  • Identify high-risk pregnancies; counsel on nutrition, danger signs.
• Intranatal Care:
  • Skilled Birth Attendant (SBA) presence.
  • Promote Institutional deliveries.
  • 'Five Cleans' (Clean hands, Clean surface, Clean blade, Clean cord tie, Clean perineum/towel).
  • Active Management of Third Stage of Labor (AMTSL).
• Postnatal Care (PNC):
  • At least 3-4 postnatal visits as per national guidelines (e.g., ASHA home visits Days 0,3,7,14,21,28,42 or facility visits).
  • Counseling: danger signs (mother & newborn), breastfeeding, family planning/contraception.
• Emergency Obstetric Care (EmOC):
  • BEmOC: 6 signal functions. 📌 A MOANER (Parenteral: Antibiotics, Oxytocics, Anticonvulsants; Manual removal of placenta; Neonatal resuscitation; Assisted vaginal delivery).
  • CEmOC: BEmOC + Caesarean section + Blood transfusion services.
• Family Planning: Promote spacing methods, limiting family size.
• Key Govt. Initiatives: JSSK, JSY, PMSMA, LaQshya, Suman (Surakshit Matritva Aashwasan).

⭐ The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) guarantees free antenatal check-ups by a specialist on the 9th of every month.

High‑Yield Points - ⚡ Biggest Takeaways

• MMR is defined as maternal deaths per 100,000 live births.
• Leading causes: Hemorrhage (esp. PPH), Sepsis, Hypertensive disorders (eclampsia), Obstructed labor, and Unsafe abortions.
• Prevention pillars: Min. 4 ANC visits (IFA, TT), Institutional deliveries with Skilled Birth Attendance, and AMTSL.
• Critical: Early recognition & management of PPH and puerperal sepsis.
• Key Govt. Initiatives: JSY, JSSK, PMSMA, LaQshya.
• Global Goal (SDG 3.1): Reduce MMR to <70/100,000 live births by 2030.