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Maternal Morbidity and it’s Causes
Maternal morbidity
Maternal health is the health of the woman during pregnancy, childbirth and the post partum period, while maternal morbidity refers to the occurrence or incidence of ill health for a woman during pregnancy, childbirth and the post partum period. You will agree with me that the term maternal morbidity is an overarching one. It is an all embracing and an overwhelming term. It has attracted definitions and inputs from authors, professionals, specialists and workers in the field of medical sciences. Some of such definitions and concepts of Maternal Morbidity are;

Maternal morbidity refers to any physical or mental illness or disability directly related to pregnancy and/ or childbirth.

Maternal morbidity can also be defined as any deviation, subjective or objective, from a state of physiological or psychological well being of women (during pregnancy, childbirth and the post partum period up to 45 days or 1 year).

Maternal morbidity could also be defined as any health condition attributed to and/ or aggravated by pregnancy and childbirth that has a negative impact on the woman’s well being (WHO).

Equally, maternal morbidity can also be defined as any illness or injury caused by, aggravated by, or associated with pregnancy and childbirth.

Furthermore, maternal mortality is the unhealthy state or medical complications in women caused by pregnancy and labour or childbirth.

Motherhood should be a time of expectation and/ or with joy in the life of every woman, her family, and her community. For women in developing countries, however, the reality of motherhood is often grim and a sad one. For these women, motherhood is often marred by unforeseen dangers and complications of pregnancy and childbirth. Some die in the prime period of their lives and in great distress from haemorrhage, convulsions, obstructed labour, or severe infections after delivery or unsafe abortion. Hence as stated above, while motherhood is often a positive and fulfilling experience for some, for many others it is associated with suffering, ill health and death.

Maternal morbidity could be chronic or mild. Chronic morbidities are conditions caused by the birth process and are not life threatening, but could greatly impair the quality of life, such as fistula, uterine prolapse, and dyspareunia.

According to the United Nations Children’s Fund/ WHO/ United Nations Population Fund (1997), complicated cases such as obstetric complications that kill, obstructed or prolonged labour, puerperal sepsis, ectopic pregnancy, septic abortion, ruptured uterus, severe pre-eclampsia, anaemia, malaria, eclampsia, tuberculosis, post partum haemorrhages, and other pre existing conditions that may complicate delivery are the most common and major causes of maternal morbidity.

There are negative consequences of maternal morbidity or ill health that reach far beyond the health of the mother at the time of pregnancy and childbirth. These consequences can lead to her death. Further, morbidity or disability in the extended post partum period (this could be up to a year) can also negatively impact the health of her baby, the health of her other children and social and economic standing of her entire family. Complications (or causes) of maternal morbidity which could be directly or indirectly related to obstetric events; uterine prolapse, stress incontinence, hypertension, haemorrhoids, perineal tears, urinary tract infections (UTI), severe anaemia, depression, fistula, and ectopic pregnancy are more common in developing countries compared to developed countries.

However, based on available data, except for outcomes of the new born infant, such consequences as regards the mother are poorly studied and understood both in quality and magnitude.

Causes of Maternal Morbidity
Maternal morbidity is difficult to measure due to variation in the definition and conception of professionals in the medical field, and more importantly the wide variation in criteria to diagnose maternal morbidity. The risk factors for maternal morbidity include prolonged labour, haemorrhage, infections, preeclampsia, etc. These may not be necessarily life threatening but can have significant impact on the quality of life.

Sixty to eighty percent of maternal morbidity and deaths are due to obstetric haemorrhages, obstructed labour, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion. These direct complications are unpredictable and mostly occur within hours or days before or after delivery. The commonest long term complication of pregnancy and childbirth include:

  • Infections: There is a very high risk of having the genital organs (cervix, uterus, tubes, ovaries vagina and peritoneum) severely infected after a prolonged labour, and also when delivery or childbirth takes place in an unclean settings or environment. Equally, certain retained parts of conception abortus after unsafe abortion and delivery can lead to contraction of infections.
  • Fistula: are holes in the birth canal that allow leakage from the urethra, bladder or rectum into the vagina. They present the woman with continuous leakage of urine or faeces or both. The commonest cause of this is obstructed labour as opposed to surgery and cancer in the developed world.
  • Urine incontinence: this is characterized by the leakage of urine upon straining or standing. Prolonged labour, obstructed labour, obstetric complications are a major factor of urine incontinence.
  • Infertility: the inability of a woman to achieve pregnancy for a period of about year despite having unprotected sexual intercourse.
  • Uterine prolapse: the falling or sliding of the uterus from its normal position into the vaginal canal. The most common causes of uterine prolapsed are prolonged labour, heavy exercise, multiple childbirths, etc.
  • Nerve Damage: As a result of prolonged labour, obstetric complications, there may be compression or damage of the nerves in the pelvis (Sciatic nerve). These can cause maternal morbidity.
  • Psychosocial problems: maternal blues aggravated by other conditions. Such conditions as marital issues, environmental problems, cultural issues, religious problems, depression, shock, financial issues (poverty) and many more can cause maternal morbidity.

Some other causes of maternal morbidity are;
  • VVF (Vesico Vaginal Fistula),
  • RVF (rectro Vaginal Fistula),
  • Vaginal stenosis,
  • PID (Pelvic Inflammatory Disease),
  • Infertility,
  • DIC (Disseminated Intravascular Coagulation),
  • Amniotic fluid embolism,
  • Blood transfusion reaction,
  • Placenta previa,
  • Hysterectomy, etc.

Others, Include, pain during intercourse, anaemia, diabetes, high blood pressure, abuse etc.

Nutritional Factors of Maternal
Poor nutrition before and during delivery contributes in a variety of ways to poor maternal health (maternal morbidity), obstetric problems and poor pregnancy outcomes. Some of the medical conditions or maternal ill health which could be caused by maternal under nutrition are,

  1. Stunting: this is a medical condition caused by chronic under nutrition. It exposes women to the risk of cephalopelvic disproportion, which can cause maternal morbidity.
  2. Anaemia: this is the fall or reduction in the volume (quantity) or quality (red blood cells) of the blood. The cause may be due to inadequate intake of iron, vitamins, parasites infestation and malaria. Women with severe anaemia are therefore, more vulnerable to infection and at increased risk of death due to obstetric haemorrhage.
  3. Severe vitamin A deficiency: this condition may make women more vulnerable to obstetric complications, including infections, and associated maternal mortality. A diet of pregnant and non-pregnant women should contain daily allowance of Vitamin A of 800mg. It is good to advice women to have dark green, yellow or orange fruits and vegetables, liver as a source of vitamin A. It is recommended to give supplemental vitamin A to pregnant and lactating women, about 200,000IU during pregnancy and 500,000IU during breast feeding. But remember, high doses of vitamin A during pregnancy causes teratogenic effect on foetus (consider doses higher than 500,000 IU is toxic).
  4. Iodine deficiency: iodine deficiency increases the risk of stillbirth and spontaneous abortion. In severe iodine deficiency, it also contributes to maternal death through hypothyroidism. The daily allowance of iodine is about 150 mg and 175 mg for non-pregnant and pregnant women respectively. Diets containing iodine such as iodized salt and sea foods should be encouraged. In summary the health care provider should encourage women to take foods of varieties and able to supplement available drugs during antenatal visits (Iron, vitamin A, Iodine etc).
  5. Folate: It important to know that Periconceptional folate supplementation has a strong protective effect against neural tube defects. Information about folate should be made more widely available throughout the health and education systems. Women whose fetuses or babies have neural tube defects should be advised of the risk of recurrence in a subsequent pregnancy and offered continuing folate supplementation. The benefits and risks of fortifying basic food stuffs, such as flour, with added folate remain unresolved.

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