Causes of Maternal Mortality

Factors that contribute to a higher risk of maternal mortality can include biomedical factors, reproductive factors, health service factors, and socioeconomic and cultural factors.

Biomedical Factors

The biomedical causes of maternal mortality are well recognised (table 1) Three quarters of maternal mortalities result from the direct obstetric complications of haemorrhage, infection, obstructed labour, hypertensive disorders of pregnancy, and septic abortion. The remainder are due to other 'direct' obstetric causes such as pulmonary embolism or ectopic pregnancy, or 'indirect' causes that are aggravated by pregnancy, such as malaria, hepatitis, diabetes mellitus and heart disease. Worldwide the most common cause of maternal mortality is haemorrhage, but the proportion due to each cause varies between regions.

It has been estimated that approximately 40% of women may suffer an acute problem in pregnancy, and 9-15% may experience a problem needing higher level care.

Table 1: Causes of Maternal Mortality

Cause	Perentage of Maternal Deaths
Haemorrage	24%
Infection	15%
Unsafe Abortion	13%
Hypertensive disorders of pregnancy	12%
Obstructed Labour	8%
Other direct causes*	8%
Other indirect causes**	20%

*Other direct causes include: ectopic pregnancy, embolism, anaesthesia-related causes

** Indirect causes include: anaemia, malaria, heart disease

Appropriate and timely intervention from a trained professional could prevent the majority of maternal mortalities. Table 2 illustrates that maternal mortalities do not occur instantaneously. If a system is in place to recognise problems promptly and to transport a woman to a healthcare facility where she can receive appropriate and timely treatment then the majority of maternal mortalities could be avoided.

Table 2. Time to death for most common obstetric emergencies

Cause of Death	Time to Death
Postpartum haemorrhage	2 hrs
Antepartum haemorrhage	12 hrs
Ruptured Uterus	1 days
Eclampsia (severe hypertensive disorder of pregnancy)	2 days
Obstructed Labour	3 days
Infection	6 days

Reproductive factors

The risk of a woman dying in pregnancy and childbirth depends on the number of pregnancies she has in her lifetime. The higher the number of pregnancies the greater the lifetime risk of pregnancy related death. maternal mortality rates are also higher among very young women, those aged 35 years and older and those with four or more children.

Health service factors

The prevention of maternal mortality requires access to healthcare services providing prompt recognition and treatment of pregnancy related complications. However in developing countries there are often inadequate facilities available and a lack of trained staff, equipment and supplies. Additionally, where services do exist, their costs may be prohibitively expensive for the majority of the population.

Socio-economic and cultural factors

The ability of women to command resources and make independent decisions about their fertility, their health and healthcare also has an impact on maternal mortality. Where women are afforded a low status in society their health needs are often neglected, and existing health facilities may not be accessed by women in need. Additionally, lack of education and understanding around health related issues can contribute to delays in seeking care when it is needed or to the inappropriate management of life threatening pregnancy complications.