Direct Obstetric<unk> s Overview Direct obstetric<unk> s are due to complications of pregnancy, birth, termination or complications arising from their management. The causes of<unk>  vary by region and level of access. According to a study published in the Lancet which covered the period from 1990 to 2013, the most common causes of<unk>  world-wide are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labor (6%). Other causes include blood clots (3%) and pre-existing conditions (28%). Descriptions by Condition Postpartum bleeding happens when there is uncontrollable bleeding from the uterus, cervix or vaginal wall after bleeding. This can happen when the uterus does not contract correctly after birth, there is left over placenta in the uterus, or there are cuts in the cervix or vagina from birth. Hypertensive disorders of pregnancy happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of the blood vessels, likely because of the placenta. This includes medical conditions like gestational hypertension and pre-eclampsia. Postpartum infections are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge. Obstructed labor happens when the baby does not properly move into the pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled at a way that does not allow it to pass through the pelvis and birth canal. Blood clots can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lung, as well as travel to the heart or brain, leading to complications. Unsafe abortion When abortion is legal and accessible, it is widely regarded as safer than carrying a pregnancy to term and delivery. In fact, a study published in the journal Obstetrics & Gynecology reported that in the United States, carrying a pregnancy to term and delivering a baby comes with 14 times increased risk of<unk>  as compared to a legal abortion. However, in many regions of the world, abortion is not legal and can be unsafe.<unk> s caused by improperly performed procedures are preventable and contribute 13% to the maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of<unk>  worldwide. Unsafe abortion is another major cause of<unk>  worldwide. In regions where abortion is legal and accessible, abortion is safe and does not contribute greatly to overall rates of<unk> . However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of<unk> . According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions. Unsafe abortion practices are defined by the WHO as procedures that are performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean. Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries. Complications include hemorrhage, infection, sepsis and genital trauma. Rates Infographic - History of Maternal Mortality in India There are four primary types of data sources that are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy is a systematic tool that is used to collect information on the cause of<unk>  from laypeople and not medical professionals. Confidential enquires for<unk> s do not occur very often on a national level in most countries. Registration systems are usually considered the "gold-standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all<unk> s. Another concern for registration systems is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many<unk> s occurring during these pregnancies and deliveries may not be properly record through these methods. There are also issues with using verbal autopsies and other forms of survey in recording<unk>  rates. For example, the family's willingness to participate after the loss of a loved one, misclassification of the cause of<unk> , and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, an potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications to seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion is common since it is more likely to be legally restrictive and/or more highly stigmatizing. Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of<unk> s related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in the abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming more safe or less safe with respect to the overall mortality of women. Prevention SDG 3 The prevention and reduction of maternity<unk>  is one of the United Nation's Sustainable Development Goals, specifically Goal 3, "Good health and well being". Promoting effective contraceptive use and information distributed to a wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow the easier accessibility of these medications. However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check ups and proper implementation of diets during pregnancy and lactation also contributes to its prevention. Indirect Obstetric<unk> s Indirect obstetric<unk> s are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy . Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or non-obstetrical<unk> s. Indirect causes include malaria, anemia, HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it. Risk factors associated with increased<unk>  include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and cesarean delivery. Risk Factors According to a 2004 WHO publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and<unk>  during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage,endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to<unk> . The leading cause of<unk>  for girls at the age of 15 in developing countries is complication through pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births. However, in the United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old. Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in<unk> . Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase<unk> s. Causes of<unk>  in the US Pregnancy-related<unk> s between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions, and the following are some of the more common causes related to<unk> : cardiovascular diseases (15.2%.), non-cardiovascular diseases (14.7%), infection or sepsis (12.8%), hemorrhage (11.5%), cardiomyopathy (10.3%), pulmonary embolism (9.1%), cerebrovascular accidents (7.4%), hypertensive disorders of pregnancy (6.8%), amniotic fluid embolism (5.5%), and anesthesia complications (0.3%). Three delays model The three delays model addresses three critical factors that inhibit women from receiving appropriate maternal health care. These factors include: # Delay in seeking care # Delay in reaching care # Delay in receiving adequate and appropriate care Delays in seeking care are due to the decisions made by the women who are pregnant and/or other decision-making individuals. Decision-making individuals can
Maternal death
Stillbirth
Maternal near miss
Fetal-maternal haemorrhage
After-birth abortion
Unsafe abortion
Maternal-fetal conflict
Forced pregnancy