Causes of Maternal Mortality
The leading causes of maternal death are classified as direct or indirect. Direct causes are those related to obstetric complications of pregnancy, labor and delivery, and the post-partum periods. Direct causes account for 80% of maternal death.* Indirect causes* are those relating to pre-existing medical conditions that may be aggravated by the physiologic demands of pregnancy. A brief overview of the leading causes of maternal death in the developing world follows.
Some causes of maternal mortality are the same in the developing and developed world however the prevalence is significantly lower in the developed world. In fact, according to Minino, et al, in the United States, "only 0.06% of women with direct obstetric complications died in facilities. This is well below the maximum acceptable case fatality rate of 1% as per UN guidelines. The most frequent cause of death was complications predominantly in the puerperium (28%), which was followed by pre-eclampsia, and eclampsia (21%)."
Note: These cannot be predicted.
Hemorrhage (uncontrolled bleeding)
- Accounts for approximately 25% of maternal deaths and is the single most serious risk to maternal health.
- Blood loss during pregnancy, labor, or post-partum.
- Can rapidly lead to death without medical intervention.
- Can be treated with blood transfusions, oxytocics (drugs which induce uterine contractions to stop bleeding), and/or manual removal of the placenta.
- Accounts for approximately 15% of maternal deaths.
- Related to poor hygiene and infection control during delivery or to the presence of untreated sexually transmitted infections during pregnancy.
- Can be prevented or managed with high standards for infection control, appropriate prenatal testing and treatment of maternal infection, and appropriate use of intravenous or intramuscular antibiotics during labor and post-partum period.
- Accounts for approximately 12% of maternal deaths
- Pre-eclampsia (also know as toxemia of pregnancy) is characterized by hypertension (high blood pressure), proteinurea (protein in the urine, general edema (swelling), and sudden weight gain. If left untreated, can lead to eclampsia.
- Eclampsia is characterized by kidney failure, seizures, and coma during pregnancy or post-partum. Can lead to maternal and/or infant death.
- Pre-eclampsia can be identified in the prenatal period by monitoring blood pressure, screening urine for protein, and through physical assessment.
- Treatment available during childbirth includes the use of sedative or anti-convulsant drugs.
Prolonged or Obstructed Labor
- Accounts for 8% of maternal deaths.
- Caused by cephalopelvic disproportion (CPD), a disproportion between the size of the fetal head and the maternal pelvis; or by the position of the fetus at the time of delivery.
- Increased incidence among women with poor nutritional status
- Use of assisted vaginal delivery methods such as forceps, vacuum extractor, or performing a Caesarean Section can prevent adverse outcomes.
- CPD is the leading cause of obstetrical fistula
- Accounts for approximately 13% of maternal deaths.
- In some parts of the world unsafe abortion accounts for 1/3 of maternal deaths.
- Approximately 67,000 cases of abortion related deaths occur each year.
- Can be prevented by providing safe abortion, quality family planning services, and competent post-abortion care.
- Accounts for approximately 20% of maternal deaths.
- Pre-existing medical conditions such as anemia, malaria, hepatitis, heart disease, and HIV/AIDS can increase the risk of maternal death.
- Risk of adverse outcomes can be reduced through prenatal identification and treatment as well as the availability of appropriate basic emergency obstetric care (EmOC) at the time of delivery.
For every maternal death there are approximately thirty times as many cases of pregnancy related illness or disability. For example, obstetric fistula (an opening between the bladder and the vagina) is usually the result of obstructed labor. It causes incontinence (the inability to hold urine). Although fistulas are preventable with good obstetric care, they have tragic consequences for many women, who are often left abandoned and isolated.