Factors that increase maternal death can be direct or indirect. The leading cause of indirect maternal death was cardiovascular disease 15. The leading cause of maternal death remains cardiac disease. Direct obstetric case fatality rate measure evaluation. Most worryingly, the number of maternal deaths due to indirect causes has. For further details on this indicator and on classification of direct and indirect causes of maternal deaths, see who et al. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data from england and wales and contemporary data from ghana, rwanda and south africa. Introduction maternal mortality, also known as maternal death, continues to be the major cause of death among women of reproductive age in many countries and remains a serious public health issue especially in developing countries who, 2007.
Violence as a direct cause of and indirect contributor to. Maternal mortality is defined by the world health organization as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. An indirect cause of death in pregnant women is from a condition that is not directly related to the pregnancy but develops or gets worse during pregnancy. It is unknown how the context in which women live contributes to their risk of obstetric or violent death during pregnancy and the postpartum period. According to the united nations population fund, thailand has one of the lowest mmrs of the southeast asia region to which thailand belongs 4. Causes of maternal deaths and their percentage are shown in table no.
The who application of icd10 to deaths during pregnancy, childbirth and. Mortality from obstetricrelated causes is on the rise, and pregnancyassociated homicide remains a leading cause of death. In september 2000, 189 world leaders signed a declaration on eight millennium development goals mdgs to improve the lives of women, men, and children in their respective countries united nations general assembly 2000. Causes of maternal mortality direct 42% lusaka, zambia, 199697 indirect 58% direct 34% kisumu, kenya 200308. The common causes of direct maternal mortality were similar in all countries and included amniotic fluid embolism, eclampsia, obstetric haemorrhage and thromboembolism. The report states that most maternal deaths in the uk now occur in women with preexisting or new onset medical and psychiatric conditions indirect causes. The direct causes of maternal deaths were largely bleeding postpartum haemorrhage pph, intrapartum haemorrhage iph, and antepartum haemorrhage aph, pregnancy induced hypertension pih, sepsis, and abortions. An introduction to maternal mortality pubmed central pmc. The abortion category includes induced abortion, miscarriage, and ectopic pregnancy. The highest maternal mortality rates are in africa, with a lifetime risk of 1 in 16.
Direct maternal deaths are those that result directly from complications of pregnancy or its management, such as obstetric haemorrhage. Most notably, cdc has been involved in a wide range of activities that address the major causes of perinatal, maternal, and under 5 morbidity and mortality. Indirect causes include anemia, malaria, and heart disease. In a 2009 article on maternal morbidity, the authors said, that generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death, that is a pregnancyrelated death in a patient with a. A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The leading direct causes of maternal deaths in kenya are shown in figure 3. Maternal deaths can be caused by a variety of indirect and direct factors. Indirect causes of maternal mortality sciencedirect.
The indirect causes of death were mainly anaemia and malaria in pregnancy. Maternal deaths in australia 20122014, classification of. Direct causes such as embolism, hemorrhage, hypertension, unsafe abortion, and other direct causes contributed to 73% of global maternal deaths whereas 27% of maternal deaths were associated with indirect causes such as hiv infection, dm, anemia, etc. The direct obstetric case fatality rate also can be calculated for all facilities other than just for emoc facilities, such as district hospitals. Last year, ten women gave birth to ten live babies. Compared to direct obstetric deaths, indirect deaths have historically received less attention from health policy makers. Conclusions the facilitybased maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Cardiac disease is the most common cause of indirect death. For analysis purposes, we grouped maternal causes of death into seven main categories of direct and indirect causes. Indirect causes of maternal death the lancet global health. New estimates show that the leading causes of maternal deaths are haemorrhage and hypertension, which together account for more than half of maternal deaths figure 4. Kassebaum and colleagues2 similarly show the growing direct and indirect effects of noncommunicable diseases on maternal mortality. Cardiac disease was the most common indirect cause of death.
Key causes of maternal death in australia in 20082012. The estimates, which referred to the year 1990, covered 174 countries. Pdf indirect causes of maternal death researchgate. In 2011, the maternal mortality ratio in thailand was 26 per 100,000 live births 2. Goal 5a calls for the reduction of maternal mortality by 75 percent between 1990 and 2015. Icd10 to deaths during pregnancy, childbirth and the. The maternal mortality committees from both countries suggest that the difference in maternal deaths due to indirect causes is because of differences in classification, rather than representing a genuine difference in risk profile or obstetric performance. The aim of this research was to examine the relationship between the direct major causes of maternal mortality and some indirect factors age, parity and gravida through a canonical correlation analysisin which a relational model was used. The leading causes of direct maternal death were obstetric haemorrhage 11, thromboembolism 10 and hypertensive disorders 9 and, when combined, these accounted for more than 61% of all direct maternal deaths. Of the direct causes of maternal death, the leading causes were obstetric hemorrhage followed by hypertensive disorders and pregnancy related infections 5. Indirect infectious causes and direct obstetrical causes direct obstetrical causes aids tb malaria pneumonia. Percent of maternal deaths due to indirect causes at emoc. Say and colleagues1 noted that 275% of all maternal deaths result from these indirect causes, with the highest proportion of such deaths in south asia and subsaharan africa. Most maternal deaths result from one or more direct causes that is, they result directly from complications of pregnancy.
Which of the following factors is not associated with halving maternal mortality in sri lanka. More needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth, say leading experts from the royal college of physicians and surgeons of glasgow and the royal college of obstetricians and. This article examines the direct and indirect effects of social and demographic measures on infant mortality using data from a church directory of the old order amish of the lancaster, pa, settlement. Levels and causes of maternal mortality and morbidity. Hypertensive states of pregnancy were the leading cause of mortality 26. Maternal mortality in the uk and the need for obstetric. Ideally, the direct obstetric case fatality rate should be calculated for all facilities rather than just for emoc facilities, such as for district hospitals. The sample includes all infant deaths and a simple random sample of survivors total n20. These include direct and indirect causes of maternal mortality, preterm birth complications, pmtct, congenital syphilis, diarrheal diseases, vaccine preventable diseases, malaria, pneumonia. Evidencebased interventions for major causes of maternal mortality. Estimation of maternal mortality using an indirect method. Unwell pregnant women should be red flagged by doctors experts call for new measures to prevent maternal deaths.
Late maternal death late maternal is death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year, after termination of pregnancy. Rwanda can complement maternal death audits with other strategies, in particular confidential enquiries. What is the greatest direct cause of maternal death. Background the original indirect sisterhood method was developed in the late 1980s as an efficient means of measuring maternal mortality through populationbased surveys, generating a variety of indicators. By mary kalerwamuyonga university of nairobi library 0258221 1 a thesis submitted in partial fulfillment of the requirements for the degree of master of arts population studies at the population studies and research institute, university of nairobi. Other direct causes include ectopic pregnancy, embolism, and anesthesiarelated complications. Indirect sisterhood method maternal mortality measurement. Maternal health infectious diseases overview briefer. Leading indirect causes include hiv and aids which account for about 26% of all maternal deaths. Pdf investigation of the relationship between direct.
Indirect maternal deaths outnumber direct deaths due to obstetric causes in many highincome countries, and there has been a significant increase in the proportion of maternal deaths due to indirect medical causes in low to middleincome countries. Number of maternal deaths due to indirect causes in emoc facilities total number of maternal deaths in the same facilities during the same period x 100. The indirect maternal mortality rate has not changed significantly since 2003. Indirect deaths, however, outnumber directs deaths in many highincome countries and are on the rise in many low and middleincome countries, irrespective of reductions in maternal mortality taking place in many settings. Perinatal mortality study zmpms of 2007 identified the leading direct causes of maternal mortality in zimbabwe as postpartum hemorrhage, pregnancy induced hypertension and puerperal sepsis. Its principles should be applicable for categorizing deaths. Of these countries, 77 had no direct or indirect estimates of maternal mortality, and their estimates were derived entirely from a statistical model. Substantially increased funding providing widespread access to midwives high female literacy rate. Causes of maternal deaths causes of maternal deaths are divided into direct and indirect causes. Direct causes were observed in 39 cases 60%, indirect maternal death in 24 cases 36.