LESSON PLAN

ON
MORTALITY, MORBIDITY
PBBSC [ N] Ⅰst YEAR
OBJECTIVES
GENERAL OBJECTIVES: By the end of the lesson plan students will be able to gain in depth of
knowledge regarding mortality and morbidity and will be able to apply the knowledge in clinical settings
to reduce mortality and morbidity.

SPECIFIC OBJECTIVES: By the end of the lesson plan students will be :

• Define maternal mortality, ratio and rate.

• Discuss the magnitude of problem of maternal mortality
• Classify the causes of maternal mortality
• Describe the factors associated with maternal mortality
• Explain in detail about steps to reduce maternal mortality
• Discuss in detail about maternal morbidity
• Explain in detain about the perinatal mortality and morbidity
S. TIME OBJECTIVES CONTENT TEAC LEARNI AV EVAL
N HING NG AIDS UATI
o ACTIV ACTIVI ON
ITY TY
1. 2 mnts Introduce the Maternal mortality is
topic of unacceptably high.
maternal m About 29500 women
died during and
2
following pregnancy and
child birth.
DEFINITION OF
Lecture writing PPT What
5min Define cum notes do you
MATERNAL
maternal discussi mean
DEATHS:
mortality, on by
Death of a woman while
ratio and pregnant or within 42 materna
rate. days of the termination l
of pregnancy mortalit
irrespective of the y
duration and the site of ratio&r
pregnancy, from any ates
cause related to or
aggravated by the
pregnancy or its
management but not
from accidental or
incidental causes.
MATERNAL
MORTALITY RATIO
(MMR):
The MMR is expressed
in terms of such maternal
deaths per100,000 live
births. In most of the
developed countries, the
MMR varies from 4-40
per 100,000 live births.
In the developing
countries, it varies from
100-700 with India
having about 254 per
100,000 live births. Most
of the figures of the
developing countries are
however, based on the
data from teaching
hospitals as very often,
the vital statistics from
the whole country are not
available.
MATERNAL
MORTALITY
RATE: Indicates the
number of maternal
deaths divided by the
number of women of
reproductive age (15-
49). It is expressed per
100,000 women of
reproductive age per
year. In India it is about
120 as compared to 0.5
of United States.
The term reproductive
mortality is used
currently to include
maternal mortality and
mortality from use of
contraceptives.
3
10 min Discuss the Lecture What
MAGNITUDE OF Abule to PPT are the
magnitude cum
THE PROBLEM:
of problem Worldwide, every year discussi follow major
of maternal on proble
approximately eight
mortality ms of
million women suffer
materna
from pregnancy-related
l
complications. Over half
mortalit
a million of them, die as
a result. The problems
y?
of maternal mortality
and morbidity are
greatest (99%) for the
poor women in the
developing countries.
One woman in 11 may
die of pregnancy related
complications in
developing countries,
compared to one in
5000 in developed
countries.

Here lies the major

discrepancies in global
health. It is further
estimated that for one
maternal death at least 16
more suffer from severe
morbidities.
Lecture
4 Classify the CLASSIFICATION: cum Listening PPT What
10 min
causes of ▪ Direct discussi are the
maternal ▪ Indirect on causes
mortality • Eclampsia 12% of
• Haemorrhage 25% meterm
• Eclampsia 12%
an
• Obstructed labour
8% mortalit
• Other direct causes y and ?
7%
• Unsafe abortion
13%
• In direct causes 20
%

• Direct obstetric
deaths (75%) are
those resulting from
complication of
pregnancy, delivery
management. Such
conditions are
abortion, ectopic
gestation, pre-
eclampsia-eclampsia,
antepartum
postpartum
haemorrhage and
puerperal sepsis.

Indirect deaths[ 25%]

(25%) include
conditions present
before or developed
during pregnancy but by
the physiological effects
of pregnancy and strain
of labour. These are
anaemia, cardiac
disease, diabetes,
thyroid disease etc, of
which anaemia is the
most important single
cause in the developing
countries. Viral hepatitis
when endemic,
contributes significantly
to maternal deaths.
aggravated
• Non-obstetric or
fortuitous deaths:
Accidents, typhoid and
5min other infectious diseases.
5
Describe Lecture
FACTORS
the factors cum Abule to PPT What
ASSOCIATED WITH
associated MATERNAL discussi follow are
with MORTALITY: on factores
maternal Age: The optimum associat
mortality reproductive efficiency ed with
appears to be between materna
20-25 years. In the l
young adolescent,
mortalit
pregnancy carries a
higher risk due to pre- y?
eclampsia, cephalo-
pelvic disproportion and
uterine inertia. In women
aged 35 years or above
the risk is 3-4 times
higher.

Parity: The risk is

slightly more in
primigravida but it is 3
times greater in para, 5
or above where
postpartum
haemorrhage,
malpresentations and
rupture uterus are more
common. The risk is
lowest in the second
pregnancy.
Socio-economic strata:
Mortality ratios are
higher in women
belonging to low socio-
economic strata as these
women are likely to be
less privileged in the
fields of nutrition,
housing, education and
antenatal care.
Antenatal care:
Unfortunately, the
women who have the
highest mortality, like
grand multi para or the
patients of lower socio-
economic status are the
women who often do not
avail the benefits of
antenatal care.
Substandard care: When
the care provided is
below the generally
accepted level, available
at that circumstances.
Shortage of resources
(Staff) or back up
facilities (Laboratory) is
also included. In the
developing countries,
avoidable social factors
are palpably evident.
These are related to:
a) Pre sence of social
evils-illiteracy, early
pregnancy, ignorance or
prejudice
(b) Unregulated fertility
and unsafe abortion
(c) Poor socio-economic
condition
(d) Inadequate
maternity services
(e) Underutilisation of
the existing services.
(f) Lack of
communication and
referral facilities.
These are most
often interrelated
and are responsible
for increased
number of
10min avoidable deaths. Lecture
6 Writing What
cum
Explain in
STEPS TO REDUCE discussi notes PPT are the
detail about steps to
MATERNAL on
steps to MORTALITY reduce
reduce (ACTIONS FOR SAFE the
maternal MOTHERHOOD): materna
mortality It is a coordinated, long l
term effort within the mortalit
families, communities and y and
the health systems. It also morbidi
involves the national ty?
legislation and policy.
Actions may vary in
respect of an individual
country. The government
must make maternal
mortality a priority public
health issue and
periodically evaluate

programmes in an effort
to prevent or minimise
maternal deaths. Specific
actions are discussed
under the following
groups Basic antenatal,
intranatal and postnatal
care (see RCH
interventions). Risk
assessment is a continued

A. Health sector actions

procedure throughout and

is not once only. • A
skilled attendant should
be present at every birth.
Functioning referral
system integration of
domiciliary and
institutional services.

• Emergency obstetric
care (EmOC) is to be
provided either by a field
staff at the door step of a
pregnant woman or
preferably at the first
referral unit (FRU).

• Good quality obstetric

services at the referral
centres are to be ensured.
Facilities for blood
transfusion, laparotomy
and caesarean section
must be available at the
FRU level.

• Prevention of unwanted
pregnancy and unsafe
abortion. All couples and
individuals should have
access to effective, client
oriented and confidential
family planning services.
• Frequent joint
consultation amongst
specialists in the
management o f medical
disorders in pregnancy
particularly anaemia,
diabetes, cardiac disease,
viral hepatitis, and
hypertension.

• Maternal mortality
conferences to evaluate
the cause of death and the
avoidable factors.

• Periodic refresher causes

for continuing education
of obstetricians, general
ancillary staff and to
highlight the preventable
factors.

practitioners, midwives
and

B. Community, Society
and Family actions
These are essential to safe
motherhood. Wide range
of groups (women's
groups), health care
professionals,

religious leaders and safe

motherhood committees
(regional, district) can
help the woman to obtain
the essential obstetric
care.

C. Health
planners/policy makers'
actions

• To organise community
education, motivation and
formation of safe
motherhood committee at
the local level.

• To strengthen the
referral system for
obstetric emergencies.
• To develop written
management protocols for
obstetric emergencies in
the hospitals.

• To improve the standard

and quality of care by
organising refresher
courses for the health care
personnel.

• Periodic audit of the

existing health care
delivery system and
to implement
changes as needed.
D.Legislative and Policy
actions

Girl children and

adolescents should
have good nutrition,
education and
economic
opportunities. They are
to be educated about
the age of sex and the
risks of unprotected
sex. Barriers to the
access of health care
facilities should be
removed. Policies
should increase
women's decision
making power as
regard to their own
health and
reproduction.