Maternal Mortality - The Medical Basics

(Memorial Quilt. Photo credit: net_efekt)

The primary medical conditions that cause maternal mortality are severe bleeding, infections, hypertensive (blood pressure) disorders, obstructed labor, and medical consequences from unsafe abortions. They cause 80% of maternal deaths.Other medical causes of maternal mortality include malaria and HIV complications, and kidney and heart failure. Access to medical care can prevent death from all of the five major causes.

Severe Bleeding

Severe bleeding, also known as maternal hemorrhage, is blood loss before, during, and after childbirth. Bleeding may be external, out through the vagina, or internal, into the abdomen. When a woman loses too much blood, she dies. It can happen for a number of physiological reasons; anemia in particular can lead to hemorrhage. However, if proper medical care is available, maternal hemorrhage is almost never fatal. That is one reason there are so few maternal deaths in the developed world.

There are some basic technologies that can be used to reduce the impact and likelihood of maternal hemorrhage. Using a drape under the mother that collects  lost blood helps health care providers estimate the severity of blood loss and know when to being treatment. Managing the delivery of the placenta after the baby is born, often by giving a hormone called oxytocin, can reduce the risk of hemorrhage.

Infections

Infections, also known as sepsis, usually develop after delivery, when the mother at home. It causes 15% of all maternal mortality, and is a major cause of infertility among women.It's more common after home births than after births that take place in a hospital.  It's more common among poor women. Anemia, poor nutrition, and prolonged labor are also factors.

The most important issue with regard to infection, though, seems to be Caesarian section - it is the biggest risk factor for maternal infections. This is a reminder that that women need access not only to medical care, but to good quality medical care. A C-section is a life-saving intervention, but it's not a surgery without risk. It should only be done if there are no other options.

Hypertensive Disorders

Hypertensive disorders, primarily eclampsia and pre-eclampsia, make up 25% of maternal mortality in the developing world.High blood pressure can lead to vascular problems, bleeding and organ failure. Pre-eclampsia is a specific kind of high blood pressure that damages the mother's kidney, liver, and blood vessels. Pre-eclampsia can develop into eclampsia which causes severe convulsions and will kill the mother and fetus if the child is not immediately delivered. These are some of the most difficult maternal deaths to prevent. Hypertensive disorders have a range of different causes, and we don't know a lot about effectively preventing them.

Obstructed Labor

Obstructed labor occurs when a woman in labor is unable to actually push the baby out. That usual happens because of cephalo-pelvic disproportion - the baby's head is too large to get through the mother's pelvic bones. It can also be caused by the fetus being positioned awkwardly in the uterus, or by malformation or trauma in the mother's pelvis. Obstructed labor can be resolved with a Caesarian section, but as discussed above, c-sections carry their own risks.

Effects of Unsafe Abortion

A safe, medical abortion has fewer risks than carrying a child to term. An abortion performed at home, by an unqualified provider, or in an unsterile environment carries serious dangers. They include serious bleeding, infection, and tearing or puncturing of the uterus. 1/3 of all abortions take place in unsafe conditions, and 500 women die every day from unsafe abortion.