Maternal death

Maternal mortality rate:

The maternal mortality rate is the maternal mortality rate per 10,000 live births or the number of maternal deaths per 100,000 live births. From the beginning of pregnancy to 42 days after delivery, all maternal deaths due to various reasons (except accidents) are counted. Because of its small ratio, the denominator is more than ten thousand or one hundred thousand.

Basic situation:

99% of all maternal deaths occur in developing countries. Maternal mortality is higher in rural areas and among poor and less educated groups. Adolescent girls face a greater risk of pregnancy complications and pregnancy death than older women. Before and after delivery and during delivery, skilled nursing can save the lives of women and newborns. Between 1990 and 2008, the maternal mortality rate across the world fell by a third.

The maternal mortality rate is unacceptably high. Approximately 1,000 women die every day from complications related to pregnancy or childbirth. Almost all of these deaths occurred in developing countries, and most of them could have been preventable.

The progress:

Improving maternal health is one of the eight Millennium Development Goals adopted by the international community in 2000. According to Millennium Development Goal 5, countries pledged to reduce maternal mortality by three-quarters between 1990 and 2015. Since 1990, the maternal mortality rate across the world has fallen by 34%.

In sub-Saharan Africa, some countries have halved the number of maternal deaths since 1990. However, from 1990 to 2008, the global maternal mortality rate (that is, the number of maternal deaths per 100,000 live births) fell by only 2.3% per year. This is far below the 5.5% annual reduction rate required to achieve Millennium Development Goal 5.

By the end of 2018, the national maternal mortality rate had dropped to 18.3 per 100,000, the infant mortality rate had dropped to 6.1‰, and the mortality rate of children under 5 had dropped to 8.4%.

Maternal mortality

Dead area:

Where did maternal deaths occur:

The high number of maternal deaths in some parts of the world reflects unequal access to medical services and highlights the gap between rich and poor countries.  More than half of these deaths occurred in sub-Saharan Africa, and one third occurred in South Asia.

The maternal mortality rate in developing countries is 290 per 100,000 births, while in developed countries it is 14 per 100,000 births. The gap between countries is very large. In some countries, the maternal mortality rate is extremely high, as many as 1,000 or more per 100,000 live births. The gap between high-income earners and low-income earners, and between urban and rural residents in various countries is also very large.

Girls under the age of 15 are at the greatest risk of death during pregnancy and childbirth. 

The lifetime risk of maternity death per woman, that is, the probability of a 15-year-old woman ultimately dying due to maternity is 1:4300 in developed countries and 1:120 in developing countries.

Cause of death:

Women die from complications during pregnancy and childbirth and after childbirth. Most of these complications are acquired during pregnancy. Other complications may occur before pregnancy, but worsen during pregnancy. The main complications that account for 80% of maternal deaths are:

Major bleeding (mostly postpartum hemorrhage)

Infection (usually after childbirth)

Hypertension in pregnancy (pre-eclampsia and eclampsia)

Dystocia

Unsafe abortion

The remaining complications are caused by diseases such as malaria, anemia and HIV/AIDS during pregnancy.

Maternal health is closely related to the health of newborns. More than 3 million newborns die every year, and another 3 million babies are stillborn.

Save lives:

Most maternal deaths are avoidable because everyone knows about health care options that can prevent or control complications. All women need prenatal care during pregnancy, skilled medical care during childbirth, and medical care and support for several weeks after childbirth. It is particularly important that all births are delivered by skilled health professionals, because timely treatment and treatment are related to the life and death of the mother.

If a woman who bleeds heavily after childbirth is left unattended, she will lose a healthy life within two hours. Oxytocin injection immediately after childbirth effectively reduces the risk of bleeding.

If you pay attention to hygiene, confirm and treat the early signs of infection in time, you can completely prevent infection after childbirth.

Before the onset of convulsions (eclampsia) and other life-threatening complications, pre-eclampsia should be detected and appropriately controlled. The administration of drugs such as magnesium sulfate to treat pre-eclampsia can reduce the risk of women suffering from eclampsia.

When the baby's head is too large relative to the mother's pelvic cavity, or when the fetus to be delivered is in an abnormal position, it will be difficult to deliver. The way to detect dystocia in the early stages of childbirth is to monitor the state of the mother and baby through the birth process chart. Doctors who are skilled in medicine can use the birth process map to identify and deal with dystocia problems and prevent the mother and baby's lives from being threatened. If necessary, a caesarean section can be performed.

In order to avoid maternal deaths, unintended pregnancy and premature pregnancy must also be prevented. All women, including girls, are required to implement family planning, receive safe abortion services strictly in accordance with the law, and receive quality care after abortion.

Care:

Poor women in remote areas simply cannot get adequate health care. This is especially true in areas with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. Although antenatal care has improved in many parts of the world in the past decade, only 66% of women in developing countries benefit from skilled medical care during childbirth. This means that millions of births are delivered without the assistance of midwives, doctors or trained nurses.

Almost all women in high-income countries have undergone at least four antenatal visits and are cared for by skilled health workers during delivery and post-natal care. In low- and middle-income countries, less than half of all pregnant women have had no less than four antenatal visits.

Other factors that prevent women from receiving or seeking medical care during pregnancy and childbirth are:

poor

Long Trip

Lack of information

Under-service

Cultural customs

In order to improve maternal health, it is necessary to identify and eliminate barriers restricting access to high-quality maternal health services at all levels of the health system.

Responses:

First cause of death:

The bleeding volume of vaginal delivery is generally around 400 ml. If within 24 hours after the fetus is delivered, the maternal bleeding exceeds 500 ml, which is medically called postpartum hemorrhage. So far, postpartum hemorrhage is still one of the main causes of maternal death. Most postpartum hemorrhage is caused by weak uterine contractions. All factors such as twin pregnancy, macrosomia, polyhydramnios, maternal age greater than 35 years, pregnancy complicated by hypertension syndrome, and frequent births are prone to uterine weakness and postpartum hemorrhage. In addition, after the fetus is delivered, if the placenta is not completely discharged in time, it will also cause postpartum hemorrhage. In addition, vaginal delivery caused by birth tract laceration and bleeding may also lead to postpartum hemorrhage. Women with coagulation dysfunction are also prone to bleeding.

The length of the delivery process varies from person to person, and the time limit for a normal delivery is a relatively extended time range. Clinically, the delivery of less than 3 hours is called acute labor. Acute labor is harmful, because in the case of acute labor, the soft tissues of the cervix, vagina, vulva, perineum, etc., cannot be fully expanded, and the fetus is delivered quickly. Such results often cause serious lacerations to the aforementioned tissues. Midwives may neglect standard operations such as disinfection and protection because they are too late to prepare for delivery, which is prone to post-partum infection and cause neonatal trauma. The fetus is delivered out of the uterine cavity too quickly, and the uterine muscle fibers are too late to contract, often bleeding after delivery. The fetus may also experience distress due to excessive and frequent uterine contractions, or suffocation immediately after delivery.

Therefore, it is not that the child is born as soon as possible, but it should be determined according to the actual situation, so do not worry about the mother or family member.

Why should obese women give birth more carefully:

Where body mass index [body mass index = weight (kg) ÷ height (m) square], those who are greater than 24 are obese. A weight gain of more than 15 kilograms during pregnancy is a significant weight gain. Obese women should be more careful during pregnancy and childbirth, because the following problems may occur: increased pregnancy complications, dystocia and surgical delivery during childbirth, and postpartum hemorrhage. According to statistics, 30% to 50% of obese pregnant women have hypertension and 10% have proteinuria. Compared with normal pregnant women, their incidence of gestational diabetes has doubled, the risk of pregnancy-induced hypertension syndrome has increased by 15 times, the rate of prolonged pregnancy has increased by two times, the length of labor has increased by two times, vaginal surgery has increased by three times, and cesarean surgery has increased by three times. The uterine birth increased by 2 times; also increased the chance of thromboembolism; the incidence of giant infants increased. Obese pregnant women gain significant weight during pregnancy, and the incidence of macrosomia is also significantly higher, which is about twice as high as that of normal pregnant women. Pregnant women who are obese before pregnancy should pay special attention to regular prenatal check-ups during pregnancy, strengthen prenatal monitoring, and promptly detect and treat pregnancy complications. Attention should be paid to nutrition during pregnancy, so that the weight gain during pregnancy should be controlled within 10 kilograms. During childbirth, be alert to the occurrence of uterine weakness, slow labor, fetal distress and neonatal asphyxia. After birth (especially within 6 hours after birth), the occurrence of asymptomatic hypoglycemia should be prevented, and breast milk or glucose can be fed early Water to prevent it.

Why does breech position occur:

Breech position is the most common abnormal fetal position, with an incidence of 3% to 4%. Breech position is more common before 30 weeks of pregnancy. After 30 weeks of pregnancy, the fetus can naturally turn to the head position to facilitate delivery. The breech position may be caused by: the fetus has a large range of motion in the uterine cavity, and the fetus can move freely in the uterine cavity due to excessive amniotic fluid or the laxity of the maternal abdominal wall, thereby forming a breech position; the fetus has a limited range of motion in the uterine cavity : Uterine malformations, fetal malformations, twin pregnancy, and excessive amniotic fluid, etc., resulting in too small space in the uterine cavity, restricted fetal movement, prone to breech position; obstruction of fetal title acceptance: pelvic stenosis, placenta previa, uterine fibroids When the baby is huge, the fetus can easily turn into a breech position.

What are the types of breech position:

According to the posture of the lower limbs of the fetus, the breech position can be divided into 3 categories: single breech presentation or straight leg presentation: the most common, the fetus has both hip joints flexed, both knee joints straightened, and the hip is the first exposed part; full buttocks Revealed or mixed breech presentation: more common, the fetus has both hips and knees flexed, as if sitting cross-knee, with the hips and feet as the presentation part; incomplete breech presentation: relatively rare, the fetus has one or both feet , One knee or both knees, or one foot and one knee are the exposed parts. 

complication

Major bleeding (mostly postpartum hemorrhage)

Infection (usually after childbirth)

Hypertension in pregnancy (pre-eclampsia and eclampsia)

Dystocia

Unsafe abortion