Maternal and Perinatal Focus Conditions and Risk Factors for These Conditions | | | | | Risk factors for condition | Risk factors for death from condition |
| Condition | Definition or complications and sequelae | Case fatality ratea (percent) | Average duration until death if condition fatal | Timing of presentation | Distal or proximate | Direct, physiological | Distal or proximate | Direct, physiological |
| Maternal |
| Hemorrhage | DefinitionSFTRETAntepartum hemorrhage: bleeding from the genital tract during the last 3 months of pregnancy | Not available | 12 hours | 28 weeks of gestation up to delivery | Primigravidity Grand multiparity (greater than 4) SFTRETFibroids SFTRETAnemia | Placental abnormalities (including placenta previa; abruption; placenta accreta, percreta, increta; other adhesions) | Remote location SFTRETAnemia SFTRETCoagulopathies | Lack of blood transfusion SFTRETBadly managed third stage of labor SFTRETDelay or absence of oxytocic treatment |
| Primary postpartum hemorrhage: excessive bleeding (more than 500 milliliters) from the genital tract following delivery | 1.0b | 2 hours | Delivery to 24 hours after delivery | | Polyhydramnios SFTRETMultiple gestation SFTRETPrevious third-stage complication SFTRETPrevious cesarean section SFTRETPreeclampsia, eclampsia SFTRETIntrauterine death SFTRETHepatitis SFTRETInduced labor SFTRETProlonged labor SFTRETPrecipitate labor SFTRETForceps delivery SFTRETCesarean section SFTRETChorioamnionitis SFTRETDisseminated intravascular coagulation | | |
| Sepsis | DefinitionSFTRETInfection of the genital tract or extragenital infections following childbirth | 1.3 | 6 days | Delivery to 6 weeks postpartum | Immunosuppression SFTRETAnemia SFTRETSexually transmitted infections SFTRETInadequate prenatal care | Prolonged labor SFTRETObstructed labor SFTRETPremature rupture of membranes SFTRETFrequent pelvic examinations SFTRETIntrauterine death SFTRETForeign body insertion (for example, herbs) SFTRETEpisiotomy SFTRETInstrumental delivery SFTRETCesarean section SFTRETUnhygienic delivery conditions SFTRETRetained products of conception | Delivery by untrained personnel SFTRETImmunosuppression SFTRETAnemia SFTRETLack of knowledge about warning signs SFTRETLack of postnatal care SFTRETCultural practices | Misdiagnosis SFTRETInappropriate use of antibiotics SFTRETLack of access to intravenous antibiotics |
| Hypertensive disorders of pregnancy | DefinitionSFTRETRaised blood pressure with proteinuria | 1.7 | 2 days (eclampsia) | 28 weeks of gestation to 2 days postpartum | Extremes of maternal age SFTRETPrimigravidity SFTRETGenetic predisposition SFTRETRacial or geographical predisposition SFTRETDiabetes and chronic hypertension SFTRETLack of prenatal care | Multiple gestations SFTRETMolar pregnancy SFTRETPrevious history of pregnancy-induced hypertension or chronic hypertension | Cultural practices SFTRETLack of knowledge SFTRETLack of prenatal care | Appearance of complications, such as cardiovascular and cerebral complications, hemolysis, elevated liver enzyme, low platelets syndrome SFTRETDisseminated intravascular coagulation SFTRETEclampsia |
| Obstructed labor | DefinitionSFTRETLabor in which progress is arrested by mechanical factors | 0.7 | 3 days | During labor | Malnutrition SFTRETRickets in childhood SFTRETBony deformity of pelvis SFTRETAchondroplasia SFTRETShort stature SFTRETPrimigravidity SFTRETGrand multiparity SFTRETAdolescent pregnancy | Cephalopelvic disproportion SFTRETMalpresentation, position | Lack of access to cesarean delivery SFTRETLack of access to instrumental delivery and symphysiotomy SFTRETScarred uterus SFTRETInappropriate use of oxytocin | Uterine rupture SFTRETHemorrhage SFTRETSepsis SFTRETExhaustion, dehydration |
| Unsafe abortion | DefinitionSFTRETProcedure for terminating an unintended pregnancy carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards or both | 0.3 | 6 hours to 6 days | After first missed period to 22 weeks of gestation or fetal weight of less than 500 grams | Unwanted pregnancy SFTRETAdolescence SFTRETUnmarried status SFTRETAbsence of legal abortion services SFTRETLack of access to contraception SFTRETLack of access to safe abortion services SFTRETSexually transmitted infections | Absence of aseptic technique SFTRETForeign body insertion SFTRETPoisoning from abortifacients | Sociocultural factors SFTRETLack of access to safe termination services SFTRETLack of access to postabortion care | Perforated uterus SFTRETPoisoning from abortifacients SFTRETPeritonitis SFTRETSeptic shock SFTRETAcute renal failure SFTRETHepatorenal failure SFTRETBowel injury, perforation SFTRETHemorrhagic shock SFTRETPeritonitis |
| Perinatal c |
| Low birthweight (less than 2,500 grams)d | Complications or sequelaeSFTRETRespiratory insufficiency in preterm infants with lung immaturity presenting as respiratory distress syndrome because of surfactant deficiencySFTRETNeonatal cerebral injury caused by periventricular hemorrhage mediated by perinatal stress such as hypotension or traumaSFTRETSevere physiological jaundice of preterm infantSFTRETDifficulties in establishing spontaneous feeding and inability to tolerate feeds resulting from prematuritySFTRETFailure of closure of the ductus arteriosus, frequently seen in preterm babies with lung diseaseSFTRETHypoglycemia and other metabolic disorders related to prematurity | 50SFTRET80SFTRET50SFTRET20SFTRET70SFTRET2 | 5 daysSFTRET3 daysSFTRET1-5 daysSFTRET1-14 daysSFTRET3 days to monthsSFTRET7 days | Less than 24 hoursSFTRET1-4 daysSFTRET2-5 daysSFTRETFirst daySFTRET3-14 daysSFTRETBirth | Extremes of maternal ageSFTRETRace, ethnicitySFTRETLow socioeconomic statusSFTRETUnmarried statusSFTRETLack of educationSFTRETParity (0 or greater than 4)SFTRETSmoking, alcohol useSFTRETMaternal malnutritionSFTRETMaternal diabetes or hypertensionSFTRETGenetic factorsSFTRETRubella, other viral infectionSFTRETPoor obstetric historySFTRETDiethylstilboestrol, other toxic exposureSFTRETHigh altitudeSFTRETAbsent or inadequate prenatal care | Multiple pregnancySFTRETShort interpregnancy intervalSFTRETFirst or second trimester bleedingSFTRETPlacenta previaSFTRETPreeclampsiaSFTRETAnemiaSFTRETHyperemesisSFTRETIsoimmunizationSFTRETFetal abnormalitiesSFTRETCervical incompetenceSFTRETOligohydramnios or polyhydramnios | Lack of adequate neonatal care facilitySFTRETLack of knowledge and understanding | Birth asphyxiaSFTRETIntraventricular hemorrhageSFTRETCentral nervous system injurySFTRETRespiratory infectionSFTRETRespiratory distress syndromeSFTRETNecrotizing enterocolitisSFTRETCholestatic liver diseaseSFTRETOther infectionsSFTRETSudden infant death syndromeSFTRETNeonatal coagulopathy |
| Birth asphyxia (excluding birth trauma) | Complications or sequelaeSFTRETAbsent or depressed breathing at birth SFTRETNeonatal encephalopathy: clinically evident disturbance in neurological behavior, commonly with early neonatal seizures in term babies, resulting from an event causing hypoxia during delivery | 20 SFTRET30 | 20 minutes SFTRET3 days to life | Birth (5 minutes) SFTRETBirth to first 12 hours | Drugs taken during labor, including anesthesia SFTRETMaternal diabetes SFTRETMaternal hypertension SFTRETPreeclampsia SFTRETAny other severe illness | Prolonged or obstructed labor SFTRETAbruptio placentae SFTRETPlacental infarct, insufficiency SFTRETPostmaturity SFTRETPrematurity or low birthweight SFTRETMultiple pregnancies SFTRETPlacenta previa or separation SFTRETCord prolapse | Badly conducted labor SFTRETLack of fetal monitoring SFTRETLack of partograph SFTRETLack of neonatal resuscitation facilities | Central nervous system injury SFTRETNeonatal encephalopathy (seizures and recurrent apnea) |
| Infection | Complications or sequelaeSFTRETNeonatal sepsis of early onset resulting from intrauterine or intrapartum infection SFTRETNeonatal sepsis of late onset resulting from nosocomial infection or lack of immunity to commensal bacteria SFTRETTetanus neonatorum, commonly resulting from unhygienic cutting of the cord or care of the cord stump SFTRETCongenital syphilis resulting from transplacental infection with Treponema pallidum after 18 weeks gestation SFTRETHIV infection transmitted either intrapartum or postpartum | 30-40 SFTRET15 SFTRET80 SFTRET30 | 5 days SFTRET5 days SFTRET3-7 days SFTRET5 days | First 3 days SFTRETAfter 3 days SFTRET3-14 days SFTRETBirth onward SFTRETDirect effects mainly after neonatal period | Lack of adequate prenatal care SFTRETMaternal infection SFTRETLack of maternal immunization SFTRETUnhygienic cultural practices | Premature rupture of membranes SFTRETPreterm delivery SFTRETBirth asphyxia SFTRETUnhygienic delivery and cord care | Congenital HIV infection SFTRETLack of adequate neonatal care | Preterm delivery SFTRETSeptic shock SFTRETRespiratory failure SFTRETHepatorenal failure SFTRETCoagulopathies |
