Maternal mortality

Maternal mortality is the mortality of pregnant women (after 28 weeks of pregnancy, childbirth and the puerperium, calculated in relation to a specific number of deliveries (abroad - the number of children born alive). In addition, the maternal mortality abroad include mortality from abortions, not included in the calculation of maternal mortality in the USSR. However, in the USSR to maternal mortality attributed deaths from extra genital diseases not included in the calculation of this indicator abroad.
During the years of Soviet power, maternal mortality decreased by more than 20 times. Among the causes of maternal mortality, the first place belongs uterine bleeding, extragenital diseases, toxicosis of pregnancy (mainly eclampsia, rupture of the uterus, postnatal septic diseases.
Bleeding pregnant women most often occurs as a result of presentation of children's place, premature detachment of the child. The majority of maternal deaths as a result of bleeding in childbirth occur in succession and the early postpartum periods. In the presence of the placenta in the uterus and blood loss of more than 350-400 ml should start manual separation and separation of the placenta. The midwife or nurse, working independently, without the direct guidance of a doctor, should be able to produce these manipulations. At the same time it is necessary to make a transfusion of blood and blood solutions (on doctor's prescription and under its control). In his absence (at impossibility of timely arrival to the patient), the midwife or nurse have the right to perform these operations at term (life) indications: shock, acute anemia and other
The main causes of maternal mortality from extragenital diseases are diseases of the cardiovascular system: hypotension, hypertension, organic diseases of the heart failure and stenoses mitral valve, myocarditis, coronary artery disease). Pregnant women with disorders of blood circulation hospitalized and left in the hospital till clinical recovery or until delivery. All pregnant women with cardiovascular disease regardless of the state of health to be hospitalised in a maternity hospital two weeks before the birth.
Among the reasons of postnatal septic diseases include infectious diseases (flu, quinsy, etc.) and chronic inflammatory processes (tonsillitis, otitis media , and others) in pregnant women.
The largest share of maternal deaths occurring at the age of most of the high fertility (20-34 years). The maternal mortality rate is the lowest in nulliparous, with the increase in the number of birth, this indicator is growing.
In the fight against maternal mortality is important that the correct organization of services for pregnant women. Doctors, medical assistants and midwives should carefully observe pregnant with aggravated obstetric anamnesis (repeated abortions, with the operation caesarean section and others), as well as for pregnant women with large fetal anomalies position of the fetus, with extragenital diseases; if necessary Promptly to be hospitalized.
A significant reduction in maternal mortality achieved in the improvement of preventive work antenatal clinics and maternity hospitals.

Maternal mortality - the number of deaths associated with pregnancy at term of not less than 28 weeks, childbirth and in the postpartum period, calculated per 1000 births. The maternal mortality rate.- one of the main indicators of quality obstetric institutions.
In tsarist Russia from birth died every year more than 30 thousand women. M. S. mainly accounted for postpartum diseases - the so-called maternity fever. Currently, M. S. decreased in comparison with the pre-revolutionary period of more than 15 times, and in comparison with 1940 - more than 3 times and was in the whole of the USSR in 1964 0,57 per 1000 births.
Among the causes of maternal mortality are on the top of the disease, not dependent on pregnancy and childbirth - the so-called extragenital diseases; followed by bleeding during pregnancy, birth and the early postpartum period, eclampsia and postnatal septic diseases.
The main reasons M. S. from extragenital diseases are diseases of the cardiovascular system: hypotension, hypertension, organic diseases of the heart failure and stenoses mitral valve, myocarditis, coronary insufficiency). They constitute more than 80% of all causes of death in pregnancy, childbirth and the puerperium. Patients who during pregnancy comes the violation of blood circulation, will be hospitalized at the hospital and leave there until full recovery or until delivery. All pregnant women with cardiovascular disease, regardless of health status are hospitalized in maternity hospital two weeks before the start of labor activity. When a compensated heart defects childbirth are conservatively assuming continuous medical supervision. Caesarean section in women with cardio-vascular system occurs primarily in the presence of complicating circumstances (narrow pelvis, previa children's beds, large fruit and so on). The operation is shown as a last resort when progressive decompensation, if there are no conditions for careful delivery through the birth canal.
During pregnancy bleeding occurs as a result of presentation of the children from premature detachment normally situated child. The greatest number of maternal deaths as a result of bleeding in childbirth occur in succession and early postnatal periods. In the normal course of childbirth, postpartum period usually lasts from 15 minutes to 2 hours. Total blood loss is 100-150 ml. of blood loss from 250 to 400 ml should be considered as the border between physiological and pathological. Need to recover motor function of the uterus, in the presence of the placenta in the uterus and blood loss in excess of 350 to 400 ml, it is necessary to begin an immediate manual separation and removal of the placenta. At the same time it is necessary to combat anemia (blood transfusion or blood fluid, heart drugs, oxygen, hot tea, and so on). The number of transfused blood depends on the General condition of women and the nature of bleeding. If blood loss exceeds 700-800 ml, should be poured at least 70-80% of the lost blood. All medical aid for bleeding is in place.