Maternal Mortality Maternal death – death of a woman while pregnant or within 42 days of TOP from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes Direct death – death from obstetric complications, interventions, omissions, incorrect treatment or from a chain of events resulting from any of the above Indirect death – death from a previous existing disease or disease that developed during pregnancy and was not due to direct obstetric causes but was aggravated by the physiological effects of pregnancy Late death – death between 42 days and 1 yr after abortion, miscarriage or delivery due to direct or indirect maternal causes Coincidental death – death from an unrelated cause which happens to occur in pregnancy or the puerperium Maternal Mortality rate – deaths/100,000 maternities Perinatal period – 22week gestation to 7 days after birth Neonatal period – birth to 28 days Low birth weight < 2500g Very low birth weight < 1500g Extremely low birth weight <1000g Preterm <37 completed weeks Term = 37-42 complete weeks Post term > 42 completed weeks Risk Factors Age – extremes of maternal age à increased risk Parity – over parity of 4 à increased risk Social Class – lower social class à higher risk Ethnicity – black & asian women à higher risk Direct Causes of Death Thrombosis & thromboembolism – increased risk if >35yrs, PMH/FH, obesity, bed rest Early pregnancy – ectopic pregnancy (misdiagnosis), TOP Hypertensive disease – esp PET Genital tract sepsis – puerperal sepsis Amniotic fluid embolism – usually if induced/c-section Haemorrhage – placenta praevia, abruptio placentae, PPH Anaesthesia – reduced if spinal/epidural rather than GA Indirect Causes of Death Cardiac disease – women with pulmonary vascular disease (eg eisenmengers syn) should be advised against pregnancy Psychiatric – 10% of new mothers suffer depressive symptoms, increased risk if prev psych history