Maternal Mortality Rate

3rd Stage community project 1st group

Supervisor: Dr. Enas Abdullah Done by: ¾ Mohammed Khalil (Chairman) ¾ Marwa Mahmood (Presenter) ¾ Noor Abdulkhaliq (Reporter) ¾ Ali Mohammed

¾ Omar Musa’id ¾ Alhikam Mustafa ¾ Noor Thamir ¾ Samah Muflih ¾ Ali Khair Aldin ¾ Mohammed Mahdi (4th stage)

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SUMMARY The health of a community can be judged by assessment of maternal mortality.. This study was conducted in Tikrit Teaching Hospital (TTH) to assess the maternal mortality rate during the past four years. All the data were collected from the hospital records of the last 4 years (2004, 2005, 2006 and 2007) by our team members, then they were classified and studied accurately to assess the mortality rate according to the criteria of the definition. During the study, it was found that young aged women with first pregnancy are more prone to mortality than other groups. We have concluded that the maternal mortality rate is very high (71.52).

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ACKNOWLEDGEMENT

We would like to thank Dr. Enas for her great help and scientific supervision..

Special thanks and best wishes for all who helped us in the statistical unit of TTH.

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CONTENTS Subject

Page Number

Title

I

Summary

II

Acknowledgement

III

Contents

1

Abbreviations

2

Introduction

3

Materials and methods

5

Results

6

Discussion

9

Conclusion

11

Recommendations

12

References

13

Appendix

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1

ABBREVIATIONS • ICD-10: The Tenth Revision of the International Classification of Diseases.

• IMoH: Iraqi Ministry of Health.

• MMR: Maternal Mortality Rate.

• TTH: Tikrit Teaching Hospital.

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INTRODUCTION

A

healthy community must identify the causes and decreases the incidence of maternal mortality..

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Miniño AM, Heron MP, Murphy SL, Kochankek, KD. Deaths: Final Data for 2004. National vital statistics reports; vol 55 no 19. Hyattsville, MD: National Center for Health Statistics. 2007.

Measures of maternal mortality Maternal mortality is difficult to measure for both conceptual and practical reasons. Maternal deaths are hard to identify precisely because this require information about deaths among women of reproductive age, pregnancy status at or near the time of death, and the medical cause of death. All three components can be difficult to measure accurately, particularly in settings where deaths are not comprehensively reported through the vital registration system and where there is no medical certification of cause of death. Moreover, even when overall levels of maternal mortality are high, maternal deaths are nonetheless relatively rare events and thus prone to measurement error, as a result, all existing estimates of maternal mortality are subject to greater or lesser degrees of uncertainty. (2) There are three distinct measures of maternal mortality in widespread use: the maternal mortality rate, the maternal mortality ratio and the lifetime risk of maternal death.

WHO. International classification of diseases. Tenth revision. Geneva, WHO; 2004.

Definition The Tenth Revision of the International Classification of Diseases (ICD-10) defines a maternal death 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. (1)

1. To determine the commonest causes of maternal mortality. 2. To determine the relationship between number of pregnancies and maternal mortality. 3. To find the common related factors to maternal mortality like para and gravida. 4. To identify the relation between maternal mortality and age of mother.

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A. Abdulraziq. Assessment of maternal mortality in Alneel hospital. Statref publications; 2004.

The most commonly used measure, the maternal mortality rate (MMR), which we are aiming to find in this study, is the number of maternal deaths during a given time period per 100,000 live births during the same time period. This is a measure of the risk of death once a woman has become pregnant. This MMR was found to be approximately 30.2 per 100,000 live births in a study conducted in Alexandria in Egypt during 2004. (3) Maternal mortality ratio is the number of maternal deaths in a given period per 100,000 women of reproductive age during the same time period, reflects the frequency with which women are exposed to risk through fertility. The lifetime risk of maternal death takes into account both the probability of becoming pregnant and the probability of dying as a result of that pregnancy. The aim of our study is to describe the pattern of maternal mortality in TTH after the invasion. The objectives needed to accomplish this aim are:

MATERIALS AND METHODS The study was a retrospective type conducted in TTH during the period from Sunday the 2nd to Wednesday to the 19th of March 2008. Data collection was done using the hospital’s data records for the maternal deaths of the past four years: 2004, 2005, 2006 and 2007. The information were collected and analyzed by the group members, so that child-bearing age women were recognized first after noticing their marital statuses, then their pregnancy statuses were identified, and finally deaths from incidental or accidental causes were excluded from the assessment. The results are mentioned and discussed in the following sections.

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RESULTS The maternal mortality rate was found to be 71.52 per 100,000 live births in TTH during the past four years. This was calculated by multiplying the number of mortalities (10) by 100,000 then dividing the product by the number of live births (13982). This is shown together with the mortality rates of each year in the following table: Year

Criteria: Mortality Live Births Mortality rate

2004 0 2983 0

2005 3 3789 79.17

2006 3 3216 93.28

2007 4 3994 100.15

Sum & mean 10 13982 71.52

Table 1: Maternal mortality rate in each year

The following table shows that most of the maternal mortality occurs among the urban women (70%): Residence Urban

2004 0

Rural

0

YEAR 2005 2006 2 3 1

0

Total

2007 2

7 (70%)

2

3 (30%)

Table 2: Relation between maternal mortality and residence

It is evident in the following table that the more dangerous maternal age group is that under 20 years of age which obtained 60% of the mortalities followed by that older than 35 years of age (30%):

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Age group

Residence <20

20-35

>35

Urban mortality

4

1

2

Rural mortality

2

0

1

6 (60%)

1 (10%)

3 (30%)

Total

Table 3: Relation between age group and maternal mortality

The following table shows that the primigravida is more dangerous to women and may cause mortality more often (60%): Age group

Maternal mortality in cases of:

primigravida

Multigravida

<20 years

3

3

20-35 years

1

0

>35 years

2

1

6 (60%)

4 (40%)

Total

Table 4: Relation between parity and age group of maternal mortality

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Finally the causes of maternal mortality are shown with their frequencies in the following table: Causes of maternal mortality

Cases

Uncontrolled severe uterine bleeding

6 (60%)

Uterine rupture

3 (30%)

Hypertension

1 (10%)

Table 5: Different causes of maternal mortality

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DISCUSSION

Murad M. K. Statistical notes about maternal mortality. Statref publications; 2007.

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T. A. Dalley. Important epidemiological data. USA, Elsevier medical publications; 2006.

The MMR during the past four years was found to be 71.52 in TTH; this is shown in table (1). This result was calculated in respect to the definition of the MMR which states that it must be recorded per 100,000 live births during the same time period of the maternal mortality estimation, so the number of mortalities during the past four years (10) was multiplied by 100,000 then the product was divided by the number of live births during the same four years (13982) to get the accurate MMR which is (71.52). While during 2004 MMR was found to be 13.1 in the United States. (4) Also in table (1) it is evident that there is a dangerous increase in the MMR since 2004, and this is expected to be a direct result of the general decline in the health care services since the beginning of the invasion in 2003 (see graph (1) in the appendix). In table (2) we can notice that most of the mortality cases were among the urban mothers (70%), and this may be due to the lifestyle and physical activity differences that make the rural resident mothers’ body build stronger and more capable of child bearing than the urban mothers. This finding differs slightly from a study conducted in Jordan last year which stated that the MMR is more or less the same between urban and rural living mothers. (5) Most of the mortality cases occur in the age group below 20 years (60%), this is shown in table (3), and can be explained physiologically and anatomically by the incomplete maturation of the mother’s uterus.

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Valerie P., Brian W. Deaths among pregnant women. Aafp web publications; 2003.

In table (4), it is interesting to note that the first pregnancy is more dangerous and may lead to mortality more often than the second or third pregnancy (60%/40%) because the risk of mortality will decrease in multigravida because of the accommodation that takes place in the mother’s body for child bearing. Causes of maternal mortality we found in our work were mentioned in table (5) with their frequencies, (see graph (2) I the appendix). The most common cause of death was the uterine bleeding (60%), followed by uterine rupture (30%) then hypertension during pregnancy (10%). These causes were almost the same as those mentioned by a study conducted in Leon about the same subject in 2002, which included in addition to these some other rare causes like ovarian neuritis.(6) At last, it should be mentioned that the final result obtained about MMR (71.52) may be much higher because of the unreliable registration system that is found in our country, i.e. most of the medical staff do not understand the exact meaning of maternal mortality, and may explain it simply as the death of the mother during labor. So the true numbers may be much higher than those reported.

CONCLUSIONS 1. In general, the maternal mortality rate is too high (71.52). 2. The MMR is increasing since 2004. 3. Women under 20 years of age are more prone for mortality. 4. The first pregnancy is more dangerous after 35 years of age. 5. Urban women have a greater risk of maternal mortality than rural resident women. 6. The most common cause of maternal mortality is uterine bleeding (60%).

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RECOMMENDATIONS For families 1. Special care should be taken for pregnant women under 20 years of age. 2. Good attention should be paid for women over 35 years of age undergoing their first pregnancy. 3. Any bleeding tendency or drug sensitivity must be reported. For IMoH 1. To educate the medical staff the exact and correct meaning of maternal mortality. 2. To emphasize on the importance of statistical recording of this subject.

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REFERENCES 1. WHO. International classification of diseases. Tenth revision. Geneva, WHO; 2004. 2. Miniño AM, Heron MP, Murphy SL, Kochankek, KD. Deaths: Final Data for 2004. National vital statistics reports; vol 55 no 19. Hyattsville, MD: National Center for Health Statistics. 2007. 3. A. Abdulraziq. Assessment of maternal mortality in Alneel hospital. Statref publications; 2004. 4. T. A. Dalley. Important epidemiological data. USA, Elsevier medical publications; 2006. 5. Murad M. K. Statistical notes about maternal mortality. Statref publications; 2007. 6. Valerie P., Brian W. Deaths among pregnant women. Aafp web publications; 2003.

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APPENDIX

120 93.28

100

100.15

79.17

80 60

MMR

40 20

0

0 2004

2005

2006

2007

Graph (1): MMR in the past four years in TTH

30%

10%

Uterine bleeding Ruptured uterus Hypertension

60% Graph (2): Different causes of maternal mortality

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