Author: Anusree Sreedeep Nair
Maternal deaths are known to have both biological and socio-cultural causes. With a focus on biological reasons, the International Classification of Diseases (ICD) divided causes of maternal deaths into direct obstetric deaths and indirect obstetric deaths. Direct and indirect obstetric deaths need to be defined in order to delve deeper into the diseases and complications during pregnancy. Natural obstetric deaths refer to mortality due to complications or illnesses that arrive during pregnancy or childbirth. In contrast, indirect obstetric deaths refer to fatality due to pre-existing conditions or complications that are not of obstetric origin (or not impacted by pregnancy). This classification has gradually lost relevance since many biomedical causes have not been identified or are often misclassified as direct or indirect.
The most commonly observed causes include the following:
1. Severe bleeding post-childbirth, which is medically referred to as Postpartum Hemorrhage or PPH. This occurs when the uterus fails to provide muscular contractions that apply pressure on the blood vessels to which the placenta was attached before delivery. After delivery, the plates begin to bleed, and weak contractions of the uterus allow them to bleed freely. This results in a lot of blood loss, which can prove fatal. PPH is also known to be caused by the tearing of the cervix, blood clotting disorders, problems related to the placenta, etc. Mothers at higher risk of PPH include those who suffer from obesity, high blood pressure levels, and those who have had many pregnancies or are in the midst of a multiple-baby pregnancy. This is considered to be a direct obstetric death.
2. Maternal Anemia, a condition associated with low hemoglobin levels (< 12g/dL) in a mother’s blood, is another prominent cause of maternal mortality, especially in Southeast Asian countries. It is known to account for about fifty percent of all global maternal deaths. Anemia is observed in most women but has far-reaching consequences for pregnant women ranging from morbidity to mortality. It is primarily due to an iron deficiency, which results from a lack of iron-rich foods or supplements in the diet. During childbirth, the lack or absence of this essential mineral can lead to a circulatory shock. This is often classified as an indirect obstetric death.
3. Preeclampsia is a condition characterized by high blood pressure levels in pregnant women and damage to organs such as the kidney or liver. Although the definite cause of preeclampsia has still not been identified by medical specialists, it is known to have genetic roots and links to lifestyle and diet as well. Eclampsia is a severe condition of preeclampsia that causes seizures, often leading to maternal hypoxia (lack of oxygen supply) and damage to the central nervous system. Since the cause of both illnesses is not well defined, they cannot be exclusively classified as either direct or indirect. Nonetheless, they are often referred to as ‘direct obstetric deaths.’
When it comes to the cardiovascular causes that have been the source of conversation and research among doctors and obstetricians, these factors have a lot more to contribute to maternal mortality than was assumed. Cardiovascular problems are some of the leading causes of maternal mortality in the US, particularly cardiomyopathy. Although there is no clear cause of cardiomyopathy, specialists believe that this condition occurs with higher rates of blood pumping throughout the body, in addition to other risk factors. Cardiomyopathy is a rare type of heart failure, and pregnant women struggling with obesity, diabetes, and malnutrition are at a higher risk for this health problem. Many statistics also indicate that cardiomyopathy is a common cause of maternal death among women of African American descent.