Hemorrhage was the main direct cause of maternal mortality globally, accounting for 27.1 percent of maternal fatalities (19.9–36.2). Postpartum haemorrhage accounted for more than two-thirds of all reported haemorrhage fatalities (table 2). The second most prevalent direct cause globally (14*0 percent, 11*1-17*4) was hypertension. Indirect causes of death comprised the remaining 3*7 percent of maternal deaths.
The main direct cause of global maternal mortality is also the leading cause of death among women of reproductive age. For example, postpartum hemorrhage is the leading cause of maternal death in developing countries and the third most common cause of death in developed countries after cardiovascular disease and accidents.
The major risk factors for hemorrhage include: inadequate access to emergency care, poor quality of anticoagulants or blood products, and lack of compliance with guidelines on the use of oral contraceptives or anti-coagulation medications. Other risk factors include young age, high parity, previous cesareans, chronic hypertension, diabetes, anemia, and obesity. Indirect risks factors are related to the health system and includes lack of awareness about signs of danger during pregnancy, delay in seeking treatment once symptoms appear, and lack of adequate care while waiting for an appointment.
Globally, approximately half of all maternal deaths occur in just five countries: India, Pakistan, Bangladesh, Nigeria, and Indonesia. These same countries account for almost 80 percent of all pregnancies worldwide.
Postpartum hemorrhage (33 percent), pregnancy-induced hypertension (16 percent), and sepsis were the most direct causes of mother fatalities (11 percent ). Anemia and malaria in pregnancy were the leading indirect causes of mortality. These two factors combined accounted for 70 percent of all deaths.
Anaemia is a major cause of death during pregnancy and after childbirth in developing countries. During early pregnancy, when more red blood cells are needed to transport oxygen to the growing embryo or fetus, women lose blood through their stools and urine. The amount of blood lost each day is about 0.5 milliliters (ml) for every 100 grams of body weight. After delivery, their iron stores are depleted even further. Women need about 8 mg of iron per day during pregnancy, but this amount cannot be obtained from food alone. Iron supplements are therefore required to meet this demand.
Malaria during pregnancy can lead to premature birth, low birth weight, and death of the infant. It also increases the risk of having a miscarriage or stillbirth. A woman's immune system is weakened when she is pregnant, making her more susceptible to diseases such as malaria.
Tuberculosis (TB) is an infectious disease that can affect people's lungs. If not treated, it can spread to other parts of the body including the brain and heart.
Haemorrhage (21.8 percent), abortion (20.7 percent), hypertensive disorders (19.4 percent), infections (9.1 percent), and ectopic pregnancy were the top five reasons of maternal mortality (8.7 percent ).
The leading cause of maternal death is haemorrhage for both developed and developing countries. The most common causes of haemorrhage are antepartum/postpartum bleeding, uterine atony, and genital tract trauma. The treatment for haemorrhage includes blood transfusions, medication, and surgery.
Ghana's maternal mortality rate is high compared with other countries in the region. In 2016, data from the Ghana Health Service showed that 870 women died during or following childbirth. This represents a decrease from 1,069 deaths recorded in 2005 but remains high compared with many other countries in Africa where maternal mortality is estimated to be below 10 per 100,000 births.
There are several factors that may have contributed to the high rate of maternal mortality in Ghana. One of these is the lack of adequate care during labor and delivery. In many cases, women do not receive any type of anesthesia during childbirth which can lead to severe pain and trauma to the body. Without adequate pain relief, some women may choose to abort their pregnancies which also increases their risk of dying during or after childbirth.
Obstructed labor is the leading cause of maternal mortality; maternal fatalities related to hypertensive disorders and hemorrhage are on the rise. The number of women dying from indirect causes such as obstructed labor is higher than the number who die from direct causes such as postpartum hemorrhage.
Indirect causes of maternal mortality include infections, anemia, malnutrition, and other health problems that develop before or during pregnancy or after the baby is born. These conditions make mothers more vulnerable to complications during childbirth.
Direct causes of maternal mortality include complications during delivery/abortion/post-abortion care (PAC), hemorrhage, eclampsia/pre-eclampsia, infection, and suicide.
The five most common causes of maternal mortality in Ethiopia are obstructed labor, anemia, malaria, HIV/AIDS, and hypertension. Other factors such as tuberculosis, diabetes, organ failure, heart disease, and chronic lung disease also contribute to maternal mortality.
Ethiopia has one of the highest rates of maternal mortality in Africa. In a study conducted by WHO in 2010, Ethiopia had a ratio of 380 deaths per 100,000 live births compared with 410 in Nigeria and 920 in South Africa.
The reasons of maternal death vary greatly and are dependent on the age of the mother when she dies. Endometrial cancer is also a significant cause of postpartum death.
Hemorrhage is the leading cause of maternal death both during pregnancy and up to one year following childbirth. The main cause of hemorrhage during pregnancy is uterine rupture due to an abnormally strong uterine muscle called a myoma. Myomas are benign tumors that can develop in the uterus. They usually go away after giving birth but some people with multiple myomas need surgery to remove them. Uterine ruptures can be difficult to diagnose because there are no specific symptoms until it is too late. The best way to prevent this complication is to have a vaginal delivery between 38 and 42 weeks' gestation for women with a history of prior cesareans. Women with a previous cesarean section who want more than one child should consider having a vaginal birth after their second cesarean section (VBAC). Vaginal births after previous cesareans are safer than repeat cesareans, but they do carry additional risks such as higher rates of uterine rupture. Cardiovascular disease is the second leading cause of maternal death during pregnancy and the postpartum period.
A review of the available data on the 39 maternal fatalities that occurred during pregnancy or during the first 42 days after birth revealed that the most prevalent causes of direct maternal death were thromboembolism (4), amniotic fluid embolism (3), and haemorrhage due to aberrant placentation (3). (2). The leading cause of perinatal mortality was also considered to be antepartum complications, including sepsis and premature rupture of membranes. These results indicate that poor management of obstetric emergencies is a major factor contributing to maternal and perinatal mortality.
In addition to the above factors, malaria, HIV/AIDS, tuberculosis, syphilis, and chancroid were identified as important contributors to the global burden of disease from pregnancy-related conditions. It is estimated that these five infections account for more than one third of all maternal deaths worldwide. Prevention efforts should therefore focus on reducing these preventable causes of death.
Improvements in maternal health have been achieved through increased access to antenatal care, safe abortion procedures, and improved management of severe acute illnesses. However, progress has been hindered by the fact that many low-income countries lack sufficient numbers of physicians who are trained in obstetrics and gynaecology. This is especially true in sub-Saharan Africa, where less than 5% of medical doctors work in the field of obstetrics and gynaecology.
There is also a shortage of facilities that can provide emergency obstetric care.
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