Fellows’ Lecture: Maternal Mortality to Maternal Health

The Academy of Sciences Malaysia organised a Fellows’ Lecture on 18 October 2018 titled Maternal Mortality to Maternal Health conducted by Professor Dato’ Dr Ravindran Jegasothy FASc.

Malaysia has successfully reduced maternal mortality through several efforts, which include the overall socio-economic development of the country, the provision of health services and auditing maternal deaths by the Confidential Enquiry into Maternal Deaths (CEMD).

Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Maternal death can be due to direct causes (obstetric complications e.g. postpartum hemorrhage), indirect (e.g. cardiac disease during pregnancy) or fortuitous deaths (e.g. motor vehicular accidents).

The MMR is used for international reporting and comparison and is calculated as such: (number of maternal deaths in a year/number of live births in the same year) x 100,000

Only deaths caused by direct and indirect causes are included.

According to Professor Dato’ Dr Ravindran, the Maternal Mortality Rate in Malaysia has been on a decline since 1933 and has been kept low ever since.

Formulation and enforcement of various acts and legislations as well as formal training and education for both professionals and the general public have contributed towards the reduction of maternal mortality.

The statistics presented also categorised maternal mortality by ethnicity, age and phases of pregnancy as well as place of delivery.

Maternal mortality statistics were also presented based on delivery location (e.g. home, government or private hospital), as well as by practice of family planning.

An analysis on the factors based on preventable deaths in 2012 showed that clinical factors beat patient factor as the main contributor only by a slight margin. Followed by non-clinical factors.

The main clinical factor of maternal death is inadequate, inappropriate or delayed treatment as well as failure to appreciate severity; the main contributing non-clinical factor was inadequate handling of emergency cases.

Contributory patient factors include non-compliance to therapy, admission, and advice; inadequate or un-booked visits ranked highest under this category.

Through his lecture, Professor Dato’ Dr Ravindran presented several lessons: he stated that maternal deaths would increase, but it can be reduced; in addition, higher risk of death is directly proportionate to parity and the mother’s age.

He also proposed for the implementation of recommendations to be audited, in addition to several measures to reduce maternal deaths such as availability of blood in all hospitals, adequate colloids and crystalloids and pre-delivery stay for patients in remote areas.

Dato’ Ravindran continued with the Confidential Enquiry into Maternal Deaths (CEMD).

The Confidential Enquiry into Maternal Deaths (CEMD) focuses upon remediable factors in the health system, relying on the collation of data between Vital Statistics and the Family Health Division (FHD) and the cooperation of the Department of Registration in indicating maternal deaths on death certificates.

Since introducing the CEMD, efforts have been made to improve reporting by encouraging active capture of maternal deaths. Collaboration with the Department of Registration allows for inclusion of information on the death certificates of all women to indicate if it was a maternal death or not. Being non-punitive and possessing an anonymised reporting system also encourages better data yield.

The CEMD could greatly impact existing policies as well as assist in formulating new ones in the effort to improve maternal health; this could translate into strengthened infrastructure by way of alternative birthing centres as well as improved communications and equipments.

The CEMD is recognized by international agencies, such as the World Health Organisation (WHO), Safe Motherhood Interagnecy Group, and Care International, among others.