MATERNAL
MORTALITY RATE
Ms. Amin pratima
MSc N 1st year,
Obstetrics and Gynecology
CMC Vellore
MMR
Total no. of female death due to complications of pregnancy
, childbirth or within 42 days of delivery, from “puerperal
causes” in an area during a given year
X1000
Total no. of live births in the same area and year
2
3
4
Chart Title
130
122
113
103
97 94 97
92
2.4
2 4.4
2 3
1.8 5
2.8
2015 2016 2017 2018 2019 2020 2021 2022
Series 1 Series 2 Series 3
5
6
CAUSES
Medical - obstetric Non- obstetric Social
• Hemorrhage • Anemia • Parity
• Infection • Cardiac diseases • Malnutrition
• Eclampsia • Malignancy • Lack of Maternity
• Obstructed labour • Hepatic and renal services
• Abortions disease • Poor emergency
management
7
NATIONAL HEALTH
SCHEMES
NRHM – National Rural Health Mission
JSY – Janani Suraksha Yojana
JSSK – Janani Shishu Suraksha Karyakram
PMSMA – Pradhan Mantri Surakshit Matritva Abhiyan
8
PROGRAMMES CONT.
RCH – Reproductive and Child Health Programme
ICDS – Integrated Child Development service
Mission Indradhanush
Pradhan Mantri Matru Vandana Yojana
9
THANK YOU
EPIDEMIOLOGY
Frequency, distribution and determinants of health
Specified population
Aim – to control the problem
Measurement of mortality and morbidity
11
VITAL STATISTICS
Statistics on the principal events in the life of an individual
MCH status – measurement of mortality and morbidity
12
Statistics
Morbidity Mortality
Incidence Prevalence
13
MORBIDITY
State of having a specific illness or condition
Acute or chronic
E.g. Birth asphyxia, preeclampsia
Incidence – new cases of illness or condition over a period
of time
Prevalence – population with the disease –
new cases + existing cases
14
MORTALITY
No. of deaths occurring due to a specific illness or
condition
Mortality rate
15
16
MCH INDICATORS
Maternal mortality rate
Maternal morbidity rate
Perinatal mortality rate
Still birth rate
Neonatal mortality rate
Total fertility rate
17
MATERNAL MORTALITY
The death of woman while pregnant or within 42 days of
termination of pregnancy, from any cause related to or
aggravated by the pregnancy or its management, in a
specified population over a specified period of time
Death due to puerperal causes
18
TYPES
Pregnancy related
Late maternal death
death
• Death of women • Death after 42 days
while pregnant but less than 1 year
after TOP
19
MATERNAL MORBIDITY
Any physical or mental illness or disability related to
pregnancy or childbirth that results into life threatening
conditions or poor quality of life
No. of women with one or more life threatening
complications of pregnancy/childbirth/PN period till 1 year
10,000 confirmed pregnancies
20
FETAL DEATH
Death prior to complete expulsion or extraction from the
mother .
Before birth – in the uterus
Death – absence of breath, no beating of heart,no
pulsation of umbilical cord or movement
22
STILL BIRTH RATE
Death of fetus weighing 1000g (≈28 wks) or more
Fetal death weighing over 1000g at birth during the year
X1000
Total live + still births over 1000g in 1 year
23
NEONATAL MORTALITY
RATE
Death occurring during the neonatal period – birth till 28
days.
NMR= neonatal deaths in a given year per 1000 live births
in that year
No. of children under 28 days of age in a year
Total live births in the same year
24
TYPES
NMR
Early Neonatal Late Neonatal
Mortality rate Mortality rate
25
EARLY NEONATAL DEATH
RATE
Neonatal deaths less than 7 days
1000 live births
26
LATE NEONATAL
MORTALITY RATE
Neonatal deaths 7 to 28 days of life
1000 live births
27
CAUSES
Preterm birth
Neonatal Sepsis
RDS
Diarrhea
Congenital anomalies
Birth asphyxia
Hemolytic disease of newborn
28
PERINATAL MORTALITY
RATE
Perinatal period – from 28th week of gestation to the 1st
week after birth
Late fetal death (>28wks)+ early neonatal death (1 st 7
days) in a year
Live births in a year
29
CAUSES
Unknown
Antenatal Intranatal Postnatal
cause
• Maternal • Birth injuries • Prematurity • Not clinically
disease • Asphyxia • RDS identified
• Pelvic disease • Obstetric • Congenital
• Uterine complications anomalies
anomalies
• Blood
incompatibilit
ies
30
MAGNITUDE
RATE 2015 2021
• NMR • 36.25 • 19.12
• MMR • 130 • 97
31
MANAGEMENT
Before During
pregnancy pregnancy
Delivery Neonatal
and PN period
32
BEFORE PREGNANCY
Delayed child-bearing
Well spaced pregnancies
Well nourished mother
Avoid drugs, alcohol tobacco
Tetanus and Rubella immunization
Female education
33
DURING PREGNANCY
High risk approach
Quality ANC
Birth & emergency preparedness
Early detection and treatment of complications
Monitor maternal and fetal wellbeing
Prevention and treatment of anemia
34
DELIVERY AND POSTNATAL
PERIOD
Safe and clean delivery
Skilled attendant
Emergency obstetric care
Newborn resuscitation
Initiation of early breastfeeding
Management of neonatal complications
35
NEONATAL PERIOD
Maintain warm chain
Rooming-in with the mother
Exclusive breastfeeding
Management of diseases of newborn
immunization
36
TRENDS
Majority deaths – poor states – Assam, UP, MP
Age – 20-29 years
Rural and tribal regions – northern & north-eastern states
Cause
Hemorrhage (47%)
Infection (12%)
HTN (7%)
Others
37
CONCLUSION
Maternal and neonatal mortality continues to be significant
public health issue, especially in low income countries,
where access to quality maternal and neonatal health is
compromised. As nursing professionals, let us provide
appropriate care and work towards reducing the mortality
rate
38
RECAP
Maternal mortality rate
Maternal morbidity rate
Fetal death
Still birth rate
Neonatal mortality rate
Perinatal mortality rate
Management and prevention
39
ANY DOUBTS ?
40
ASSIGNMENT
Read up on Total Fertility Rate
41
BIBLIOGRAPHY
K. Park, Textbook of Preventive and Social Medicine, 24 th
Edition, Bhanot Publishers.
Rajvir Bhalwar, Textbook of Community Medicine, 4 th
Edition, Wolters Kluwer Publication
Trends in Maternal Mortality in India over two decades in
Nationally representative surveys
WHO world statistics records - 2022
42
TRUE OR FALSE ?
43
1. Early neonatal mortality rate is death of neonates from 7-
28 days of life.
2. Hemorrhage is the most common cause of MMR.
3. Still birth rate is for deaths of fetus weighing 1000g (≈28
wks) or more.
4. Mortality is related presence of sickness or illness.
5. Perinatal mortality is fetal death + late neonatal mortality
rate
44
1.False
2.True
3.True
4.False
5.False
45
