SALSO
TABLE OF CONTENTS
PAGE
MATERNAL MORTALITY 2
MECHANISM OF LABOUR 11
PARTOGRAPH & DYSFUNCTIONAL LABOUR 20
MONITORING IN LABOUR 29
CARDIOPULMONARY RESUSCITATION 43
ANTEPARTUM HAEMORRHAGE 48
POSTPARTUM HAEMORRHAGE 52
BLOOD COMPONENTS & TRANSFUSION 64
RETAINED PLACENTA 70
UTERINE INVERSION 74
SHOULDER DYSTOCIA 79
BREECH & EXTERNAL CEPHALIC VERSION 89
TWIN PREGNANCY 96
CORD PROLAPSE 100
INSTRUMENTAL DELIVERY 103
HYPERTENSIVE DISORDERS OF PREGNANCY 112
~1~
, SALSO
MATERNAL MORTALITY
Objectives
Know the definition of maternal deaths.
Understand the common causes of maternal death in Malaysia and Sarawak.
Introduction
The national objective is to reduce the maternal mortality to less than 20/100,000 LB. For
Sarawak, with the present coverage of health facilities at one health clinic for an area of
631.7 sq. km (ranging from 1:98.9 in Samarahan district to 1:3880.6 in Belaga district),
and the professional to population ratio of 1:16,032.1 (ranging from 1:4175 in Daro
district to 1:32,300 in Meradong district), this objective is a challenge to achieve.
Definition
Maternal deaths
Maternal death has been defined as the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the duration and site of pregnancy, from
any cause related to or aggravated by the pregnancy or its management, and from other
causes not related to or caused by the pregnancy
Direct maternal Death
Deaths resulting from obstetric complications of the pregnant state (pregnancy, labour
and puerperium) from interventions, omissions, incorrect treatment or from a chain of
events resulting from any of the above.
Indirect maternal death
Deaths resulting from previous existing disease or disease that developed during
pregnancy and which was not due to direct obstetric causes but which was aggravated by
the physiologic effects of pregnancy.
Fortuitous death
Deaths from other causes not related to or influenced by pregnancy, which happen to
occur in pregnancy or the puerperium.
Maternal Mortality Rate
Maternal mortality rate (MMR) is the number of women who die from pregnancy related
causes during pregnancy and within 42 days of childbirth, per 100,000 live births.
Excluding accidental or incidental causes
Illegal immigrants are not included although each case is investigated
MMR = No of women dies
100,000 live births
~2~
, SALSO
Millennium Developmental Goals (MDG 5)
Aim to improve maternal health
Target 5A
Reduce maternal mortality ratio by three quarters, between 1990 and 2015.
Target 5B
Achieve, by 2015, universal access to reproductive health.
Trend from 1990 - 2015
Globally, Maternal Mortality Ratio fell by 44% with estimated MMR 216 maternal death
per 100000 live births from 385 per 100000 live births. Hence, the target of reducing
Maternal Mortality Ratio by 75% has not been achieved globally.
For Malaysia, National MMR has been plateauing for the past 10 years. MDG5 Target
for Malaysia is to achieve MMR of 11.08/100000 live births. According to the latest
CEMD report, National MMR was 25.4 in 100000 live births in 2011. Therefore,
achieving MDG5 is still a huge milestone for our country.
Sustainable Development Goal (SDG)
SDG is the continuous global effort in reducing MMR and ultimately ending preventable
maternal deaths. The target 3.1 of SDG 3 includes reducing MMR to < 70 in 100000 live
births by 2030.
Trend of maternal mortality in Malaysia
Malaysia has witnessed a significant reduction in maternal mortality rate (MMR) from
540 per 100,000 live births (LB) in 1950 to 139 in 1970. The decline has continued but
plateaued at around 27/100,000 LB from 2002 to 2005 as shown in from the graph below.
~3~
, SALSO
Trend of maternal mortality in Sarawak
There is marked reduction of MMR in the state of Sarawak. The trend of MMR for the
past 9 years are as below:
YEAR MMR ( per 100,000
live births)
2008 30.8
2009 37.0
2010 26.7
2011 25.4
2012 26.6
2013 9.3 (*achieve MDG 5
target)
2014 16.0
2015 16.0
2016 7.3
Confidential Enquires into Maternal Death
Confidential Enquires into Maternal Deaths (CEMD) involve surveillance into maternal
deaths with primary intention to identify all the maternal deaths, analyze causes and
contributors to maternal deaths at all levels of mother’s care. Key features of CEMD is
confidentiality, which means the identity of women, health care workers involved
remained anonymous. It is a process involving investigations at all levels of care for a
women, from which consensus on the cause of death and contributors to maternal death is
being made. CEMD report will include key recommendations derived from the enquiries
and report will be disseminated so that remedial actions can be put into practice to reduce
maternal death.
CEMD Report 2009 - 2011
Executive Summary
1. 834 pregnancy related deaths were reported from 2009 – 2011.
2. Maternal Mortality ratio in 2011 was 25.4 per 100000 live births.
~4~
TABLE OF CONTENTS
PAGE
MATERNAL MORTALITY 2
MECHANISM OF LABOUR 11
PARTOGRAPH & DYSFUNCTIONAL LABOUR 20
MONITORING IN LABOUR 29
CARDIOPULMONARY RESUSCITATION 43
ANTEPARTUM HAEMORRHAGE 48
POSTPARTUM HAEMORRHAGE 52
BLOOD COMPONENTS & TRANSFUSION 64
RETAINED PLACENTA 70
UTERINE INVERSION 74
SHOULDER DYSTOCIA 79
BREECH & EXTERNAL CEPHALIC VERSION 89
TWIN PREGNANCY 96
CORD PROLAPSE 100
INSTRUMENTAL DELIVERY 103
HYPERTENSIVE DISORDERS OF PREGNANCY 112
~1~
, SALSO
MATERNAL MORTALITY
Objectives
Know the definition of maternal deaths.
Understand the common causes of maternal death in Malaysia and Sarawak.
Introduction
The national objective is to reduce the maternal mortality to less than 20/100,000 LB. For
Sarawak, with the present coverage of health facilities at one health clinic for an area of
631.7 sq. km (ranging from 1:98.9 in Samarahan district to 1:3880.6 in Belaga district),
and the professional to population ratio of 1:16,032.1 (ranging from 1:4175 in Daro
district to 1:32,300 in Meradong district), this objective is a challenge to achieve.
Definition
Maternal deaths
Maternal death has been defined as the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the duration and site of pregnancy, from
any cause related to or aggravated by the pregnancy or its management, and from other
causes not related to or caused by the pregnancy
Direct maternal Death
Deaths resulting from obstetric complications of the pregnant state (pregnancy, labour
and puerperium) from interventions, omissions, incorrect treatment or from a chain of
events resulting from any of the above.
Indirect maternal death
Deaths resulting from previous existing disease or disease that developed during
pregnancy and which was not due to direct obstetric causes but which was aggravated by
the physiologic effects of pregnancy.
Fortuitous death
Deaths from other causes not related to or influenced by pregnancy, which happen to
occur in pregnancy or the puerperium.
Maternal Mortality Rate
Maternal mortality rate (MMR) is the number of women who die from pregnancy related
causes during pregnancy and within 42 days of childbirth, per 100,000 live births.
Excluding accidental or incidental causes
Illegal immigrants are not included although each case is investigated
MMR = No of women dies
100,000 live births
~2~
, SALSO
Millennium Developmental Goals (MDG 5)
Aim to improve maternal health
Target 5A
Reduce maternal mortality ratio by three quarters, between 1990 and 2015.
Target 5B
Achieve, by 2015, universal access to reproductive health.
Trend from 1990 - 2015
Globally, Maternal Mortality Ratio fell by 44% with estimated MMR 216 maternal death
per 100000 live births from 385 per 100000 live births. Hence, the target of reducing
Maternal Mortality Ratio by 75% has not been achieved globally.
For Malaysia, National MMR has been plateauing for the past 10 years. MDG5 Target
for Malaysia is to achieve MMR of 11.08/100000 live births. According to the latest
CEMD report, National MMR was 25.4 in 100000 live births in 2011. Therefore,
achieving MDG5 is still a huge milestone for our country.
Sustainable Development Goal (SDG)
SDG is the continuous global effort in reducing MMR and ultimately ending preventable
maternal deaths. The target 3.1 of SDG 3 includes reducing MMR to < 70 in 100000 live
births by 2030.
Trend of maternal mortality in Malaysia
Malaysia has witnessed a significant reduction in maternal mortality rate (MMR) from
540 per 100,000 live births (LB) in 1950 to 139 in 1970. The decline has continued but
plateaued at around 27/100,000 LB from 2002 to 2005 as shown in from the graph below.
~3~
, SALSO
Trend of maternal mortality in Sarawak
There is marked reduction of MMR in the state of Sarawak. The trend of MMR for the
past 9 years are as below:
YEAR MMR ( per 100,000
live births)
2008 30.8
2009 37.0
2010 26.7
2011 25.4
2012 26.6
2013 9.3 (*achieve MDG 5
target)
2014 16.0
2015 16.0
2016 7.3
Confidential Enquires into Maternal Death
Confidential Enquires into Maternal Deaths (CEMD) involve surveillance into maternal
deaths with primary intention to identify all the maternal deaths, analyze causes and
contributors to maternal deaths at all levels of mother’s care. Key features of CEMD is
confidentiality, which means the identity of women, health care workers involved
remained anonymous. It is a process involving investigations at all levels of care for a
women, from which consensus on the cause of death and contributors to maternal death is
being made. CEMD report will include key recommendations derived from the enquiries
and report will be disseminated so that remedial actions can be put into practice to reduce
maternal death.
CEMD Report 2009 - 2011
Executive Summary
1. 834 pregnancy related deaths were reported from 2009 – 2011.
2. Maternal Mortality ratio in 2011 was 25.4 per 100000 live births.
~4~
