Critical Review of Maternal Mortality Report Dr Waleed Barghouthi

1. Critical Review of Maternal Mortality Report Dr Waleed Barghouthi

2. Maternal mortality is not a pure medical/technical issue, but rather a rights and developmental issue. The death of a mother during pregnancy or delivery is a flagrant violation of her basic human right to life.

3. Maternal mortality: definition and causes • WHO defines maternal mortality as the death of the mother during pregnancy or delivery or within 42 days after delivery, regardless of gestational age, location of pregnancy (normal or ectopic), and whether the death occurs due to direct or indirect causes or due to any health situation that is complicated by the pregnancy or delivery or as a result of treatment of complications or any medical interventions. • MMR reflects the number of maternal deaths in a given year per 100,000 live births in the same year.

4. Most maternal deaths occur during delivery or immediately after delivery. Causes of maternal deaths are categorized in three main groups: • Direct causes related to delivery, • Indirect causes related to pregnancy and its impact on the health situation of the woman, and • Accidental causes and accidents not related to pregnancy.

5. Surveillance of maternal mortality in Palestine* A questionnaire to monitor maternal mortality was developed by a team of health professionals from the primary health care (PHC) department and the information systems unit, drawing on experiences from other countries and local experiences.

6. Causes of death: • Direct causes: 8 cases • Pulmonary embolism 21.7%  • Bleeding 4.3% • Eclampsia 4.3% • Ectopic pregnancy 4.3%                                                • Indirect causes: 11 cases • Ovarian cancer 4.3% • Mesenteric thrombosis 4.3% • Systemic lupus erythrematosus 4.3% • H1N1 30.4%

7. Accidental causes: 4 cases • Organophosphorus poisoning : 4.3% • Aspiration : 4.3% • Traffic accident : 9%

8. Estimates of Maternal mortality in Palestinian Territories vary widely!!! • Why?: Absence of a well structured national monitoring system and lack of documentation in many Maternity facilities.

9. In developing countries Maternal mortality is mainly due to post partum haemorrhage • The discrepancy in our report is very serious as it reflects: 1-The lack of proper data collection 2- health professionals attitude of defending themselves by attributing most of the deaths to an unpreventable cause such as PE.

10. 3-The lack of postmortum autopsy is a major factor in the misdiagnosis of the real causes of maternal death. 4-The absence of confidential inquiry into maternal deaths, and the resort to a questionaire inquiry, which in many cases is unrealistic .

11. Other points to discuss: The report mentioned as part of causes: High fertility. {In spite of a recent decline, fertility rate remains high in comparison with Arab countries (4 in 2002) and the world (2.8 in 2002)}???

12. Private sector responsibility • In terms of the place where antenatal service was offered, it was found that in more than half the cases (15, or 53%), the deceased women received care at the private sector??. • Lack of interest by the private sector in taking active part in the formulation of national health policies and their focus on profit-making without paying the due attention to public health issues??.

13. الى شهيدات الجهل والفقر والاهمال وغياب الاستراتيجية الطبية ونقص الكفاءات الى الامهات  اللاتي قضين في سبيل انجاب مزيداً من الفلسطينيين المرابطين, عهداً علينا  نحن اطباء فلسطين ان نحاول اكثر واكثر

14. THANK YOU