Reducing Maternal and Neonatal Mortality in Indonesia Saving Lives, Saving the Future (2013) / Chapter Skim
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Chapter 3 Maternal, Fetal, and Neonatal Mortality
Chapter 3 Maternal, Fetal, and Neonatal Mortality
Pages 27-38
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From page 27... ...
It then reviews the interventions proposed to reduce these mortalities. Causes of Maternal, Fetal, and Neonatal Mortality in Low-Income Countries In most developing countries, the major medical causes of maternal mortality are hemorrhage, the hypertensive diseases of pregnancy, and various types of maternal infections, among other things (IOM, 2003; Khan et al., 2006; Ronsmans and Graham, 2006; WHO and UNICEF, 2012)
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From page 28... ...
. 0.4 Million Maternal Deaths Each Year Worldwide FIGURE 3-1 Main Causes of Maternal Mortality.
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, with permission of Elsevier. FIGURE 3-5 Maternal Mortality Ratio per 100,000 Live Births over Time and Interventions That Contributed to Decline, United States .
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With antibiotics, blood availability, and improvements in anesthesia, cesarean sections became safer and were used more frequently to terminate pregnancies that threatened the life of the mother and fetus/neonate, such as those with prolonged labor or eclampsia. Thus new and effective interventions were introduced, first in high-income countries and later in some middle-income countries, and they were responsible for the nearly 99 percent reduction in maternal mortality.
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From page 31... ...
Maternal treatment for syphilis and vaccination for tetanus contributed to the reduction of newborn infection-related mortality. The incidence of newborn asphyxia was substantially reduced with better obstetric care, including monitoring for hypoxia prenatally and during labor, and the willingness to perform cesarean sections for signs of fetal distress.
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From page 32... ...
Treatment varies with the cause of the hemorrhage and may include surgery for lacerations or a ruptured uterus, manual placental removal or a D&C for a retained placenta or placental fragments, or uterotonics to treat hemorrhage from an atonic uterus. An antepartum hemorrhage due to placental abruption or previa calls for a cesarean section.
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From page 33... ...
The use of nonsterile delivery techniques, prolonged labor, and instrumentation, including cesarean section, all increase the risk of infection. Prevention includes providing clean delivery sites, ensuring provider hand-washing, and avoiding prolonged labor and instrumentation whenever possible.
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Because saving many maternal, fetal, and newborn lives requires a cesarean section, timely access to this intervention is crucial to achieving mortality rates comparable to those in high-income countries. TABLE 3-1 Components of Basic and Comprehensive Obstetric Care Basica Comprehensive Parenteral antibiotics All components of basic care Parenteral oxytocic drugs Blood transfusion Parenteral anticonvulsants Cesarean section Manual removal of placenta Removal of retained products of conception Assisted vaginal delivery by forceps or vacuum a Neonatal resuscitation is often included in this proposed package.
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From page 35... ...
† Women receiving comprehensive emergency obstetric care are assumed to have access to the highest level of care during childbirth, including skilled care and basic emergency obstetric care if needed. SOURCE: Pattinson et al.
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, as are the treatments that prevent them. Thus it would be most efficient to have programs that focus on improving pregnancy outcomes rather than separate programs that focus on maternal mortality, stillbirth, or neonatal mortality reduction.
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From page 37... ...
2012. Trends in Maternal Mortality: 1990 to 2010.
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