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Discuss the definition of MMR

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Discuss the deaths among Palestinian women in reproductive ages- Report 2008

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Discuss MMR in Developing countries

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Reports from Governmental Hospitals in West Bank

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National Maternal Mortality Committee chaired by MOH, UNRWA, NGOs, Association OB/ Gyn

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Questionnaire for women deaths in reproductive age- 15 – 49 y

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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

Maternal Death Other Tumours Ca Bone Br.

Asthma Ca Colon Liver Tumours CVA Sepsis Trauma Renal Failure Ca.

Breast Cardiac 30 20 10 0 60 50 40

Ca. Cervix Coagulopathy Purperal sepsis Eclampsia PPH 3.5

3 2.5

2 1.5

1 0.5

0

1 2 3 4 5 8000 7000 5000 3000 2000 2 3 10 6 1

Ca nc er Ca rd ia c Ru pt ur e ut er us Se ps is pu lm on ar y em bo lis m Ec la m ps ia Am io tic fl ui d em bo lis m

23 maternal deaths from 250000 deliveries

9 8 7 6 5 4 3 2 1 0

2ةلسلستم 1ةلسلستم 3 2 1 3.5

3 2.5

2 1.5

1 0.5

0

Hospital Home Else where 23 % 2 % 75 %

Para >= 5 Para 3- 4 Para 1- 2 Nulliparous 40 35 30 25 20 15 10 5 0

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 Haemorrhage Early pregnancy/ ectopic pregnancy Pregnancy-related hypertension Sepsis Other direct causes Anaesthesia Amniotic fluid embolism

1.94

0.66

0.47

0.85

0.85

0.19

0.28

0.80

Cause of death Rate per 100,000 maternities Cardiac Psychiatric Other indirect 2.27

0.85

4.12