Perinatal

Mortality
 UNICEF strategy for reducing perinatal
mortality
Care and management during the four phases of maternal and infant care
PHASE 1: Management of prenatal care includes :
 Monitoring of quality indicators of prenatal check-ups, through ongoing data entry
and cross-referencing with official systems in the Ministry of Health, is carried out.
 Monthly reports are used to detect pregnancies, according to clinical and social risk
criteria.
 These expectant mothers receive home visits by the Family Health Team, especially
those lacking prenatal monitoring and requiring food support or a Social Mother’s
care.
 This procedure is evaluated according to clinical and socio-family profile, and one
of the key issues is the evaluation of the medical recommendations’ fulfilment.
 To promote participation in the Programme, each mother receives prenatal care and
a Pregnancy Kit.
PHASE II: Management of birth and postpartum care includes:
 Identification of risk factors for labour and the development of a care guideline or
plan, the preparation of a protocol to ensure care for pregnant women in delivery
units to avoid a ‘pilgrimage’ through various services (health centres, emergency
rooms) prior to delivery.
 At the same time, there are visits and interviews with postpartum mothers in the maternity
unit to evaluate delivery care, the use of the Mother and Child Health Card, especially in
relation to registering prenatal monitoring and the identification of risk factors in the
postpartum period and production of care plans, as well as the need for Social Mothers to
accompany women with mental health issues and no family support during delivery.
 the Social Mothers conduct home visits to postpartum women to evaluate and support their
needs.
PHASE III: Management of delivery care and neonatal period
 The activities undertaken in this phase occur from birth to 28 days of life.
 In this phase, the newborns hospitalised in maternity units are visited daily to identify the risk
factors in the neonatal period and their progress until discharge from the hospital. T
 here are home visits to provide guidance for mothers with difficulties in breast-feeding. There
is consistent communication between the Manager of the FHC and the Head of Paediatrics to
request special care for any at-risk newborn.
PHASE IV: Management for the child
 identify the at-risk infants/children, classify them according to their condition of ‘acquired
risk’ in the first two years of life and prepare the care plan, and define the accompaniment
routines for the healthy child.
 There are home visits to evaluate the need for nutritional and/or home support or hospital
accompaniment by a Social Mother.
 For those hospitalised, there are daily visits to paediatric wards to accompany children less
than two years old and observe their progress until discharge.
 The principal causes of maternal death were postpartum haemorrhage, hypertensive
disorders of pregnancy, obstetric pulmonary embolism, and associated medical conditions,
accounting for 24%, 16%, 13% and 7% of deaths respectively.

 Among the direct causes, postpartum haemorrhage was responsible for 29% of the
instances, hypertensive disorders of pregnancy for 20%, pulmonary embolism for 12%,
and puerperal sepsis for 8%.

 The haemoglobin level was below 11 g/dl in 20% of the mothers who died. With regard to
indirect causes, cardiovascular diseases accounted for 63% of deaths, while 14% and 9%
resulted from infections other than puerperal sepsis and from connective tissue diseases
respectively.

 An analysis of the 375 deaths that occurred in 1992 and 1993 showed that the maternal
mortality ratio was 53 per 100 000 live births for deliveries performed at home, whereas it
was 36 per 100 000 in government hospitals and 21 per 100 000 in private institutions.

 A lack of clinical acumen was detected in several cases in both the public and private
sectors, involving failure to diagnose, failure to appreciate the severity of a patient's
condition, therapy that was inadequate, inappropriate or delayed, and failure to adhere to
protocols. A significant proportion of these problems occurred in the postpartum period.
 Vigilance has to be maintained during the postnatal period, and
it is important to develop new protocols and to prioritize those
that already exist.
 Improved care is offered to mothers at particular risk of death
and morbidity.
 In Malaysia the risk approach involves the use of four colour
codes denoting a range of severity of obstetric problems and
providing a practical guide to nursing staff which enables them
to identify cases requiring the attention of a physician.
 A checklist is used which facilitates the early detection of
complications in the antenatal, intrapartum and postpartum
periods.
 There is a clear need for fertility regulation in high risk groups
such as grand multiparas and older mothers.
District team involvement in perinatal
mortality
References
 http://www.who.int/bulletin/archives/77(2
)190.pdf
 http://www.commonhealth.in/pdf/69.pdf
 https://www.unicef.org/lac/TREBOL_-
_INGLES(2).pdf
 http://www.un.org.my/upload/mdg5.pdf