Maternal Mortality and Pregnancy Complications - Essay Example

Maternal Mortality and Pregnancy Complications Name Institution Affiliation Maternal Mortality and Pregnancy Complications Introduction About 805 women die from pregnancy-related and childbirth-related complications around the world every day. In 2014, 293, 000 women died due to pregnancy-related complications and more than 72% of deaths occurred in low-resource settings (Wilkens, 2009). The number is unacceptable and calls for all the stakeholders to address the risk and contributing factors to this deaths. Maternal mortality Recently, Scientific American magazine released statistics revealing a worrisome trend in maternal mortality in the United States of America. Interestingly, the data indicates the mortality rate in the United States has more than doubled in the last three decades. In 1987, only 7.2 women per 100,000 died every year, and the number has increased to 18.6 deaths per 100,000 in 2014 (Atrash, Alexander, & Berg, 2012). This is against the maternal mortality trend in the developing countries in sub-Saharan Africa which have put in measures to reduce the mortality rate. Women giving birth in the US are the higher risk of succumbing to maternal complications than those giving birth in China, Saudi Arabia, and Kenya (Beekhuizen, Pembe, Fauteck, & Lotgering, 2009). America is one of the largest economies in the world, and we expect high levels of health care and low maternal death. This statistics, with respect to the financial ability, healthcare quality, and access and high literacy levels are interesting (Atrash, Koonin, Lawson, Franks, & Smith, 2009). As we learned the maternal mortality, I reflected on the US case and analyzed the factors contributing to the maternal death against the expectations. Maternal health is determined by many factors both in prenatal and postnatal periods and this case study calls for factors contributing to high maternal deaths in Australia (Wilkens, 2009). Maternal deaths in Australia are minimal, but the low number cannot be undermined as we strive to achieve the WHO millennium development goals of reducing child mortality. Australian Institute of health and welfare reported 104 maternal deaths that occurred within 42 days of the last trimester in the period between 2006 and 2012. Maternal mortality ratio was 6.7 deaths per 100,000 women who gave birth. There were 41 maternal deaths in the same periods that were directly related to pregnancy. The leading causes of maternal mortality are both direct and indirect causes. Indirect causes relate to pre-existing medical complications that are elevated by physiological demands in times of pregnancy (Cannell & McCall, 1963). These are diseases such as anemia, malaria, HIV/AIDS and hepatitis. The risk of deteriorating these complications can be reduced by the prenatal monitoring and identification and treatment and the provision of emergency obstetric care in times of delivery. Indirect complications contribute to 20% of global maternal deaths (DeSimone, Norris, & Leighton, 1990). Direct causes are emanated from obstetrical complications of the pregnancy, labor and delivery and postpartum period. 8-0% of all maternal deaths are caused by these direct causes. The causes of maternal deaths in Australia ranged from cardiac diseases, psychosocial related causes, obstetrical hemorrhage deaths ectopic pregnancies and abnormalities in the amniotic fluids. Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality. All women in the third trimester are at risk of PPH and its sequelae. PPH refers to the blood loss of more than 500ml following vaginal delivery or 1000ml after the cesarean delivery (Echternkamp & Gregory, 2010). PPH is caused by uterine the failure of the uterus to contract and retract after delivery. Other causes are the retained placenta, trauma after vigorous labor. Forceps delivery may cause cervix ulcerations and calls for inspection after such deliveries. Thrombosis in the postpartum period and blood components has a stake in PPH. Fibrin, platelets, and clotting process are important in the prevention of excessive hemorrhage. Abnormalities such as thrombocytopenia and hypofibrinogenemia or the acquired HELLP syndrome may elevate the complications, and early detection is essential to take up early measures. Active management of third stage labor reduces the incidences and severity of PPH. Uterotonic administration of oxytocin upon delivery and early gentle clamping of the cord and gentle traction reduces the PPH significantly. Sepsis Sepsis is an important cause of maternal death in the world. Sepsis manifestation ranges from the genital tract infections pregnancy complications in the last trimester that arises before or after labor. Sepsis is a bacterial infection that extends to systemic infection. Complications of sepsis are sepsis-induced organ dysfunction and septic shock (Moodley, 2008). All healthcare professional should be aware of symptoms and signs of maternal sepsis and critical illness and the rapid fatal sepsis and septic shock. Clinical signs are pyrexia, tachycardia hypothermia, impaired consciousness, and pyrexia. The common causes of sepsis are Lancefield group and beta-hemolytic streptococcus and E colli. Antimicrobial therapy and administration of broad-spectrum antibiotics is the intervention of choice for sepsis management and other supportive interventions such as dialysis. Prenatal monitoring and prenatal healthcare provision is important for the expectant mothers to reduce the chances of postnatal sepsis. Intravenous immunoglobulin (IVIG) has immunomodulatory effects and neutralizes the super antigen effect of exotoxins and inhibits the release of interleukins and tumor necrosis factors. The newborn should be monitored o detect any complication emanating from prenatal maternal sepsis. Hypersensitive disorders Hypersensitive disorders contribute for more than 11% of all maternal deaths in the world. Pre-eclampsia is characterized by toxemia, hypertension, proteinuria, and edema. These conditions may proceed to eclampsia of left untreated which is characterized by kidney failure, seizures, and coma and can lead to maternal and infant death. Pre-eclampsia can be identified in the prenatal healthcare by monitoring the blood pressure urine parameters and physical assessment. Expectant mothers should seek prenatal health care to diagnose such complications. Unsafe abortions account for approximately 11% of total maternal deaths. More than 67.500 cases of abortions related deaths occur every year (Garenne, McCaa, & Nacro, 2008). These deaths can be prevented by providing safe abortion family planning interventions and quality post-abortion care. Indirect cases account for more than 20% of total maternal deaths. Existing medical complications such as anemia, malaria, and cardiovascular diseases and HIV/AIDS increases the risk of maternal death. Risks of adverse outcomes can be reduced through prenatal identification and treatment of these complications at early stages (Ronsmans & Graham, 2006). Continuous monitoring and testing of expectant mothers throughout the gestation period to detect any complication is recommended. Pregnancy In my young age, I used to like kids and would request my parents to “purchase” a child. I felt I needed to have a young brother to play with after school. My parents would always tell me the kids are “out of stock” in the hospital. As a the only child of two qualified Veterinary Doctors, I would hear my father, my parents, discussing animal reproduction but was not bothered a lot since animals were not my best friends. Growing up I have come to like the clinical side of biology and this growing passion drove me to this profession. I recently watched my Father managing a retained after birth in equines (Horse) and a question in mind arose about the same occurrence in human. Questions I assigned myself were what causes, the risks, complications and management of retained placenta in humans. I was eager to learn this topic and relate the human and animals cases since I had vast background information about animal after birth management. Significance of retained placenta Retained placenta is an important cause of maternal mortality and morbidity in the world and mostly in developing the world. Retained placenta complicates more than 2 % of all the deliveries with a case mortality of nearly 10% in poverty stricken areas. The third stage of labor involves success detachment of the uterine caruncles and expulsion of all fetal membranes from the reproductive system (Briley & King's College London, 2014). After the delivery of the baby, the retroplacental myometrium is initially relaxed. After the contraction, the placenta shears away from the placenta wall and separate leading to spontaneous expulsion. Placenta retention occurs when the placenta myometrium fails to contract. Failure to a contract may still occur during labor leading to dysfunctional labor. Placenta retention may be due to many factors such as persistence of inhibitory factors such as progesterone at the onset of labor. The most common and effective treatment is the Manual Removal of Placenta (MROP). Immediate removal of placenta helps to avoid complications such as hemorrhage. In developing countries, (MROP) facilities are scarce, and this contributes to the high mortality associated with high mortality rates (Muller & Owens, 1974). Third stage labor The latent phase follows delivery of the fetus where all the myometrium contracts. Retroplacental myometrium contraction leads to detachment phase. This leads to detachment phase where the placenta is sheared away from the uterine cavity. Expulsion phase removes the uterus by uterine contractions (Graham, 2006).Contractions occurring before the delivery of the child is not enough to cause the detachment in the presence of a fetus. Ultrasound has reveals the cause of retained placenta is the contractile failure in the retro-placenta area. This explains the close association of retained placenta and dysfunctional labor. Factors that may contribute to this contractile failure may be biochemical abnormality, inhibitory and stimulatory factors (Wingeier & Griggs, 2011) Management of retained placenta Manual removal is the common treatment of retained placenta under anesthesia. There are risks associated with manual removal involving infective risks such of inserting the hand in the uterus. The risks are higher in developing world where the infections prevalence is high, and personnel skilled in obstetrics and anesthesia are short in supply (London, 2011). To reduce hemorrhage, the removal should be delayed by 30-60 minutes since there is less postpartum blood loss. The accrete placenta is partially removed, and the curettage is applied to remove the rest of the tissues with controlled hemorrhage. Remnants of the trophoblast are reabsorbed spontaneously. Placenta percreta allows the blood flow to continue due to the absence of myometrial physiological ligature that controls bleeding. Hysterectomy may be unavoidable in the case of this complication and use of ligatures to control bleeding. Systemic oxytocics Oxytocics give prophylactically at the delivery time increases the placental deliveries by 20-35 minutes. Oxytocics have no evidence of reducing the cases of placental retention in early days; midwives recommended nipple stimulation to stimulate the production of endogenous oxytocin. Parenteral oxytocin is given to increase the overall tone of the myometrium and stimulation of strong physic contractions (National Research Council (U.S.) et al., 2000). Misoprostol has the same effect as the oxytocin of increasing background tone and contraction strength. Umbilical vein oxytocin injections Umbilical vein injection of oxytocin allows the delivery of the oxytocin directly to the retroplacental myometrium with contractile failure. This is effective management of retained placenta as shown by a large number of studies. Conclusion Prior knowledge and experiences helped me to understand and enjoy the learning of these topics in class. I was curious to learn, analyze relate and address previous misunderstandings on this subjects. These topics will help me once I start my professional practice to assist the mothers and ensure their safety is checked. Healthcare providers should be supported by the governments in their mission of reducing maternal mortality from preventable cause. References Atrash, H. K., Alexander, S., & Berg, C. J. (2012). Maternal mortality in developed countries: Not just a concern of the past. Obstetrics and Gynecology, 3(3), 34-76. ATRASH, H. K., KOONIN, L. M., LAWSON, H. W., FRANKS, A. L., & SMITH, J. C. (2009). Maternal Mortality in the United States, 1979???86. Survey of Anesthesiology, 2(4), 43-99. Beekhuizen, H. J., Pembe, A. B., Fauteck, H., & Lotgering, F. K. (2009). Treatment of retained placenta with misoprostol: a randomized controlled trial in a low-resource setting (Tanzania). BMC Pregnancy and Childbirth, 8(2), 24-76. Briley, A., & King's College London. (2014). 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Muller, L. D., & Owens, M. J. (1974). Factors Associated with the Incidence of Retained Placentas[1] and [2]. Journal of Dairy Science, 2(3), 23-87. National Research Council (U.S.), Reed, H., Koblinsky, M. A., Mosley, W. H., Workshop on the Consequences of Pregnancy, & Maternal Morbidity, A. (2000). The consequences of maternal morbidity and maternal mortality: Report of a workshop. Washington, DC: National Academy Press. Ronsmans, C., & Graham, W. J. (2006). Maternal mortality: who, when, where, and why. Lancet, 3(2), 67-112. Wilkens, A. (2009). WHO Guidelines for the management of postpartum hemorrhage and retained placenta. Geneva: World Health Organization. WINGEIER, R., & GRIGGS, R. (2011). Management of retained placenta using infra umbilical oxytocin injection. Journal of Nurse-midwifery, 2(4), 23-34. Read More