scholarly journals Towards safe motherhood to - are we moving in the right direction?: experience from an urban health facility in South India

2019 ◽  
Vol 8 (7) ◽  
pp. 2851
Author(s):  
Ramya Thangavelu ◽  
Lalitha Natarajan
Keyword(s):  
Maternal Mortality ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Safe Motherhood ◽  
Quality Health Care ◽  
College Hospital ◽  
Mortality Ratio ◽  
Classical Triad ◽  
Maternal Suicide ◽  
The Right

Background: This study was designed to evaluate the institutional Maternal Mortality Ratio (iMMR) in our institution, a tertiary private medical college hospital and to suggest recommendations and possible interventions to reduce it.Methods: This retrospective descriptive study was conducted by reviewing the hospital records over a period of ten years from January 2009-December 2018. The case records were reviewed for maternal demographic characteristics and complications.Results: The total number of deaths during the study period was 21, giving an iMMR of 85.268 per 100000 live births. Most of the maternal deaths (>80%) occurred postpartum. Obstetric causes contributed to 57% of the deaths with hypertension and hemorrhage topping the list. Other causes were sepsis and non obstetric causes including one case of maternal suicide. 52.38% of the women died more than 48 hours after admission to the hospital, while 28.57% succumbed in less than six hours. Secondary complications noted were ICU admission, extended intubation, massive transfusion, operative intervention and multi organ dysfunction.Conclusions: The classical triad of Hypertension, Hemorrhage and Sepsis continues to be the major determinant of maternal mortality and are potentially preventable by promoting universal access to quality health care, strengthening of health services and ensuring accountability.

scholarly journals Millennium Development Goal 5 and adolescents: looking back, moving forward

2015 ◽  
Vol 100 (Suppl 1) ◽  
pp. S43-S47 ◽  
Author(s):  
Joshua P Vogel ◽  
Cynthia Pileggi-Castro ◽  
Venkatraman Chandra-Mouli ◽  
Vicky Nogueira Pileggi ◽  
João Paulo Souza ◽  
...  
Keyword(s):  
Maternal Health ◽  
Reproductive Health ◽  
Maternal Mortality ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Millennium Development Goal ◽  
Reproductive Health Services ◽  
Development Goal ◽  
Health Community ◽  
Mortality Ratio

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality.

scholarly journals Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016

2020 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Chandra Mani Dhungana
Keyword(s):  
Higher Education ◽  
Cesarean Section ◽  
Maternal Mortality ◽  
Health Surveys ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Mountain Region ◽  
Income Quintile ◽  
Demographic And Health Surveys ◽  
Mortality Ratio

Abstract Background Sustainable development goals require member countries to reduce maternal mortality ratio below 70 per 100,000 live births by 2030. Addressing inequalities in accessing emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was undertaken to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during the period of 2006 and 2016.Methods Data from the Nepal Demographic and Health Surveys (NDHS) 2006, 2011 and2016 were sourced for this study. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more childbirths) were the unit of analysis for this study. Absolute and relative inequalities in CS rates were expressed in-terms of rate difference and rate ratios, respectively. We used binary logistic regression models to assess the rate of cesarean sections by background socio-demographic characteristics of women. Results Age and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. Conclusion To improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 2, province 5, province 6 and province 7 so that universal access to comprehensive sexual and reproductive health care services is ensured. Simultaneously, there is a pressing need for policies, guidelines and continuous monitoring of CS rates to reduce overuse in rich women, women with higher education and those delivered in private facilities.

scholarly journals Safe Delivery Care: Policy, Practice and Gaps in Nepal

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Tulsi Ram Bhandari ◽  
Ganesh Dangal
Keyword(s):  
Maternal Mortality ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Skilled Birth Attendant ◽  
Safe Motherhood ◽  
Delivery Care ◽  
Care Policy ◽  
Safe Delivery ◽  
Policy Practice ◽  
Mortality Ratio

Delivery care is regarded as safe when it is attended by a skilled birth attendant either at health facility or home. Childbirth practices differ from place to place and are determined by availability and accessibility of health services. After National Health Policy (1991), Nepal has focused on safe motherhood policies and programmes. Maternal mortality ratio decreased nearly fourfold between the years 1990 to 2011. The country is likely to achieve the Millennium Development Goal (MDG) 5. However, indicators of the MDG 5: skilled care at birth and institutional delivery rates are very far from the targets. From the initial findings of limited studies, safe delivery incentive programme has been successful for increasing the skilled care at birth and institutional delivery and reducing the maternal mortality twofold between the years 1990 to 2011. In spite of numerous efforts there is a wide difference in the utilization of skilled care at birth among the women by area of residence, ecological regions, wealth quintiles, education status, age and parity of women, caste ethnicity and so forth. This difference indicates that current policies and programmes are not enough for addressing the low utilization of safe delivery care throughout the country.  Keywords: delivery practices; gaps; Nepal; place of delivery; safe delivery care policy.    

scholarly journals An analysis of trends in maternal mortality at a tertiary care teaching hospital of Western Rajasthan, India: a four year retrospective study

2017 ◽  
Vol 4 (3) ◽  
pp. 864
Author(s):  
Neha Agrawal ◽  
Sandeep Kumar Uppadhaya ◽  
Afzal Hakim ◽  
Manish Mittal
Keyword(s):  
Maternal Mortality ◽  
Health Care Services ◽  
Economic Status ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Tertiary Hospital ◽  
College Hospital ◽  
Medical College ◽  
Care Services ◽  
Mortality Ratio

Background: Maternal mortality reflects not only the adequacy of health care services of any country or state but also the standard of living and socio-economic status of the community. India is among those countries, which has a very high maternal mortality ratio; the state of Rajasthan having the third highest maternal mortality in the country. This study was done to assess the maternal mortality in a tertiary hospital situated in Jodhpur, a city in Western Rajasthan where large numbers of patients are referred from rural parts in and around the city.Methods: This study was done to assess the trends in maternal mortality at a tertiary medical college hospital situated in Western Rajasthan. A retrospective hospital based study was carried out in the Obstetrics and Gynaecology Department of Ummaid hospital, Dr S. N. Medical College situated in Jodhpur, Rajasthan, India over a period of 4 years from July 2010 to June 2014.Results: During the study period spanning 4 years, there were in total 84,746 live births with 195 maternal deaths. The mean maternal mortality ratio for the four year period was found to be 230.1 per lakh live births.Conclusions: The maternal mortality was quite high than the national average.

Maternal mortality and caesarean delivery: A five year review

1970 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Anju Huria ◽  
Reeta Mehra ◽  
Pratiksha Gupta ◽  
Bharti Goel
Keyword(s):  
Maternal Mortality ◽  
Caesarean Delivery ◽  
Maternal Mortality Ratio ◽  
Government Medical College ◽  
College Hospital ◽  
Live Births ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Mortality Ratio ◽  
June July

Aim: To find out maternal mortality related to caesarean deliveryMethods: A review of maternal mortality in Government Medical College Hospital Chandigarh, India wasconducted for the last five years. [2003 to 2007].Results: Maternal mortality ratio was found to be 496.4 per 100,000 live births and of which 23.59% wascausally or incidentally related to caesarean delivery. The caesarean delivery rates for the hospital was29.08% in 2003 and a rising trend to 36.60% in 2007 was also noted.Conclusion: Caesarean remains a good option when rationally indicated; however the maternal and fetalconditions that indicate the operative delivery may be inherently related to mortality and morbidity.Key words: Maternal mortality; maternal mortality ratio; caesarean deliveryDOI: 10.3126/njog.v4i1.3331Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 42-45

scholarly journals Review of maternal mortality in a tertiary care urban teaching hospital: 10 year retrospective study

2019 ◽  
Vol 8 (5) ◽  
pp. 2050
Author(s):  
Shobha G. ◽  
Jayashree V. Kanavi ◽  
Veena B. Divater ◽  
Annamma Thomas
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
College Hospital ◽  
Maternal Deaths ◽  
Live Births ◽  
Medical College ◽  
Mortality Ratio ◽  
Acute Fatty Liver

Background: The objectives of this study were to calculate the maternal mortality ratio, causes for maternal death in our institution and the duration of hospital admission to death interval.Methods: The study included collecting and analyzing the details of maternal death in women who were admitted to St. Johns Medical College Hospital, Bengaluru, from January 2007 to December 2016. Results: Total maternal deaths were 61 and live births were 26,001 during the study period. The maternal mortality ratio (MMR) was 234.6 per 100,000 live births. Majority of maternal deaths occurred in women aged 18 - 35 years 56 (91.80%) women, primipara 45 (73.77%) and referred cases to our institution from other hospitals 52 (85.24%).                      Most of the women died in the postnatal period 54 (88.52%). Direct obstetric causes accounted for 44 (72.13%) maternal deaths and indirect causes 17 (27.86%) deaths. Preeclampsia and eclampsia were the leading causes for death 13 (21.31%) followed by acute fatty liver of pregnancy 12 (19.67%), hemorrhage 7 (13.11%) and sepsis 6 (9.83%). Anemia was present in 77.04% of women at the time of admission to our hospital. Thirty six (59.01%) women died within a week of admission to the hospital, in which 13 (21.31%) women died in less than 24hours of admission. Twenty five (40.98%) women died after a week of admission to hospital.Conclusions: Apart from the triad of preeclampsia, obstetric haemorrhage and sepsis, acute fatty liver of pregnancy has emerged as an important cause of maternal death. Most of the maternal deaths are preventable. Early detection of complications and timely referral to tertiary care hospital in St. Johns Medical College Hospital, Bengaluru, Karnataka, India decreases maternal morbidity and mortality.

scholarly journals Communication Norms in NGOs Advocating Reproductive Health: A Comparative Study of Malaysian and Nigerian NGOs

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mumtaz Ali ◽  
Maya Khemlani David ◽  
Angela Rumina Leo
Keyword(s):  
Reproductive Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Family Health ◽  
Web Searches ◽  
The World ◽  
Health Initiatives ◽  
Mortality Ratio ◽  
The Right ◽  
Document Review

Reproductive health is an emerging issue in developing countries. The United Nations Population Fund (UNFPA) reports that every minute, a woman in the developing world dies from treatable complications of either pregnancy or childbirth. Nigeria is a country where the state of reproductive health of its population is dismal. In 2012, UNFPA pointed out that Nigeria has one of the worst maternal mortality statistics in the world with a maternal mortality ratio of 545 per 100,000 live births. Several NGOs around the world deliver services at various levels to advocate the right of mothers to have safe births as well as address the shortage of skilled midwives. In this context, Malaysia has done much to control its infant and maternal mortality rates, through its community reproductive health initiatives. This study then aims to determine the communication norms in two NGOs, one in Malaysian and the other in Nigeria. The analysis was of projects undertaken by two NGOs, the Federation of Reproductive Health Association of Malaysia (FRHAM) and the Association for Reproductive and Family Health (ARFH) of Nigeria. The communication norms and ways of getting the community involved in their projects were examined through progress reports, document review and web searches. Besides being interviewed, questionnaires were filled by the employees of the NGOs. The findings indicate that the Nigerian and Malaysian NGOs have different communication models and they can learn from each other’s best practices.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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