•Discuss the definition of MMR
•Discuss the deaths among Palestinian women in
reproductive ages- Report 2008
•Discuss MMR in Developing countries
•Reports from Governmental Hospitals in West Bank
•National Maternal Mortality Committee chaired by MOH,
UNRWA, NGOs, Association OB/ Gyn
•Questionnaire for women deaths in reproductive age- 15 –
49 y
•Emphasize the importance of obstetric care & protocols
Those related to obstetric complications during
pregnancy, labour,or puerperium( 6 weeks)
Those associated with a disorder
exacerbated by pregnancy
Unrelated to pregnancy but occur
during
Occur after 42 days from delivery
Everyday, 1500 women die from
pregnancy or childbirth related
complications. In 2005 there were an
estimated 536 000 maternal deaths
worldwide.
A total 99% of all maternal deaths
occur in developing countries
The maternal mortality ratio in
developing countries is 450 deaths
per 100 000 live births versus 9 in
developed countries
In Palestine 22% of almost 3.5 million population are women of
child-bearing age.
.Fertility rate in West Bank is 3.3
.Maternal mortality is improperly reported
. In joint reports by WHO , UNFPA, UNICEF the MMR in Palestine is
70-80 in 1995
100 in 2000
24 in 2002
. A Review by Dr. Nadim Adily on Palestine RefugeeReported an
estimate of MMR is 22.4 between 1995- 2002
60
50
40
30
20
10
0
Maternal
Other
Death Tumours
Ca Bone
Br.
Asthma
Ca Colon
Liver
Tumours
CVA
Sepsis
Trauma
Renal
Failure
Ca.
Breast
Cardiac
3.5
3
2.5
2
1.5
1
0.5
0
Ca. Cervix
Coagulopathy
Purperal
sepsis
Eclampsia
PPH
1
8000
10
2
7000
6
3
5000
2
4
3000
3
5
2000
1
on
ar
y
S
ep
si
s
ut
er
us
em
bo
lis
m
E
A
cl
m
am
io
tic
ps
f lu
ia
id
em
bo
lis
m
pu
lm
R
up
tu
re
C
ar
di
ac
C
an
ce
r
9
8
7
6
5
4
3
2
1
0
23 maternal deaths from 250000 deliveries
‫‪3.5‬‬
‫‪3‬‬
‫‪2.5‬‬
‫‪2‬‬
‫متسلسلة‪2‬‬
‫‪1.5‬‬
‫متسلسلة‪1‬‬
‫‪1‬‬
‫‪0.5‬‬
‫‪0‬‬
‫‪1‬‬
‫‪2‬‬
‫‪3‬‬
23 %
Hospital
Home
Else where
2%
75 %
40
35
30
25
20
15
10
5
0
Para >= 5
Para 3- 4
Para 1- 2
Nulliparous
Epidemiology
In the last reported triennium 295 women died from causes
directly or indirectly related to their pregnancy.2 More than two
million mothers gave birth in the United Kingdom (UK) between
the years 2003-05.
132 died of conditions that could only occur in relation to
pregnancy (Direct deaths)
163 died of underlying medical or psychiatric causes e.g. heart
disease or severe depression that were worsened by their
pregnancy (Indirect deaths)
Incidence
The mortality rate for Indirect causes of death was 7.71 per
100,000 maternities (compared to 7.76 in 2000-2002).2
The mortality rate for maternal deaths from Direct causes of
death was 6.24 per 100,000 maternities (compared to 5.31 in
2000-2002).
Cause of Death
Rate per 100,000
Maternities
Thrombosis and thrombo
embolism
1.94
Haemorrhage
0.66
Early pregnancy/ectopic
pregnancy
0.47
Pregnancy-related hypertension
0.85
Sepsis
0.85
Other direct causes
0.19
Anaesthesia
0.28
Amniotic fluid embolism
0.80
Cause of death
Rate per 100,000 maternities
Cardiac
2.27
Psychiatric
0.85
Other indirect
4.12