3rd Stage

community project
1st group

Supervisor: Dr. Enas Abdullah

Done by:
¾ Mohammed Khalil ¾ Omar Musa’id
(Chairman) ¾ Alhikam Mustafa
¾ Marwa Mahmood ¾ Noor Thamir
(Presenter) ¾ Samah Muflih
¾ Noor Abdulkhaliq ¾ Ali Khair Aldin
(Reporter) ¾ Mohammed Mahdi
¾ Ali Mohammed (4th stage)

I
SUMMARY

The health of a community can be judged by assessment of

maternal mortality..
This study was conducted in Tikrit Teaching Hospital
(TTH) to assess the maternal mortality rate during the past
four years.
All the data were collected from the hospital records of the
last 4 years (2004, 2005, 2006 and 2007) by our team members,
then they were classified and studied accurately to assess the
mortality rate according to the criteria of the definition.
During the study, it was found that young aged women with
first pregnancy are more prone to mortality than other groups.
We have concluded that the maternal mortality rate is very
high (71.52).

II
 ACKNOWLEDGEMENT

We would like to thank Dr. Enas for her great help and
scientific supervision..

Special thanks and best wishes for all who helped us in

the statistical unit of TTH.

III
CONTENTS

Subject Page Number

Title I
Summary II
Acknowledgement III
Contents 1
Abbreviations 2
Introduction 3
Materials and methods 5
Results 6
Discussion 9
Conclusion 11
Recommendations 12
References 13
Appendix 14

1
ABBREVIATIONS

• ICD-10: The Tenth Revision of the International

Classification of Diseases.

• IMoH: Iraqi Ministry of Health.

• MMR: Maternal Mortality Rate.

• TTH: Tikrit Teaching Hospital.

2
INTRODUCTION

A healthy community must identify the causes and

decreases the incidence of maternal mortality..

Definition

WHO; 2004.
revision. Geneva,
diseases. Tenth
classification of
WHO. International
The Tenth Revision of the International
Classification of Diseases (ICD-10) defines a
maternal death as: the death of a woman while
pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and site of
the pregnancy, from any cause related to or
aggravated by the pregnancy or its management
but not from accidental or incidental causes. (1)

Measures of maternal mortality

Maternal mortality is difficult to measure for
both conceptual and practical reasons. Maternal
deaths are hard to identify precisely because this
require information about deaths among women of
reproductive age, pregnancy status at or near the
time of death, and the medical cause of death. All for Health Statistics. 2007.
Hyattsville, MD: National Center
statistics reports; vol 55 no 19.
Data for 2004. National vital
SL, Kochankek, KD. Deaths: Final
Miniño AM, Heron MP, Murphy
three components can be difficult to measure
accurately, particularly in settings where deaths are
not comprehensively reported through the vital
registration system and where there is no medical
certification of cause of death. Moreover, even
when overall levels of maternal mortality are high,
maternal deaths are nonetheless relatively rare
events and thus prone to measurement error, as a
result, all existing estimates of maternal mortality
are subject to greater or lesser degrees of
uncertainty. (2)
There are three distinct measures of maternal
mortality in widespread use: the maternal mortality
rate, the maternal mortality ratio and the lifetime
risk of maternal death.

3
The most commonly used measure, the maternal
mortality rate (MMR), which we are aiming to find

publications; 2004.
hospital. Statref
mortality in Alneel
Assessment of maternal
A. Abdulraziq.
in this study, is the number of maternal deaths
during a given time period per 100,000 live births
during the same time period. This is a measure of
the risk of death once a woman has become
pregnant.
This MMR was found to be approximately 30.2
per 100,000 live births in a study conducted in
Alexandria in Egypt during 2004. (3)
Maternal mortality ratio is the number of
maternal deaths in a given period per 100,000
women of reproductive age during the same time
period, reflects the frequency with which women
are exposed to risk through fertility.
The lifetime risk of maternal death takes into
account both the probability of becoming pregnant
and the probability of dying as a result of that
pregnancy.
The aim of our study is to describe the pattern of
maternal mortality in TTH after the invasion.
The objectives needed to accomplish this aim
are:

1. To determine the commonest causes of

maternal mortality.
2. To determine the relationship between
number of pregnancies and maternal
mortality.
3. To find the common related factors to
maternal mortality like para and gravida.
4. To identify the relation between maternal
mortality and age of mother.

4
MATERIALS AND METHODS

The study was a retrospective type conducted in TTH during

the period from Sunday the 2nd to Wednesday to the 19th of
March 2008.
Data collection was done using the hospital’s data records for
the maternal deaths of the past four years: 2004, 2005, 2006 and
2007.
The information were collected and analyzed by the group
members, so that child-bearing age women were recognized first
after noticing their marital statuses, then their pregnancy statuses
were identified, and finally deaths from incidental or accidental
causes were excluded from the assessment.
The results are mentioned and discussed in the following
sections.

5
RESULTS
The maternal mortality rate was found to be 71.52 per
100,000 live births in TTH during the past four years. This was
calculated by multiplying the number of mortalities (10) by
100,000 then dividing the product by the number of live births
(13982). This is shown together with the mortality rates of each
year in the following table:

Year
Criteria: Sum & mean
2004 2005 2006 2007
Mortality 0 3 3 4 10
Live Births 2983 3789 3216 3994 13982
Mortality rate 0 79.17 93.28 100.15 71.52

Table 1: Maternal mortality rate in each year

The following table shows that most of the maternal mortality

occurs among the urban women (70%):

YEAR
Residence Total
2004 2005 2006 2007
Urban 0 2 3 2 7 (70%)
Rural 0 1 0 2 3 (30%)

Table 2: Relation between maternal mortality and residence

It is evident in the following table that the more dangerous

maternal age group is that under 20 years of age which obtained
60% of the mortalities followed by that older than 35 years of
age (30%):

6
 Age group
Residence
<20 20-35 >35
Urban mortality 4 1 2

Rural mortality 2 0 1

Total 6 (60%) 1 (10%) 3 (30%)

Table 3: Relation between age group and maternal mortality

The following table shows that the primigravida is more

dangerous to women and may cause mortality more often
(60%):

Maternal mortality in cases of:

Age group
primigravida Multigravida
<20 years 3 3

20-35 years 1 0

>35 years 2 1

Total 6 (60%) 4 (40%)

Table 4: Relation between parity and age group of maternal

mortality

7
 Finally the causes of maternal mortality are shown with their
frequencies in the following table:

Causes of maternal mortality Cases

Uncontrolled severe uterine bleeding 6 (60%)

Uterine rupture 3 (30%)

Hypertension 1 (10%)

Table 5: Different causes of maternal mortality

8
DISCUSSION
The MMR during the past four years was found
to be 71.52 in TTH; this is shown in table (1). This

publications; 2006.
Elsevier medical
epidemiological data. USA,
T. A. Dalley. Important
result was calculated in respect to the definition of
the MMR which states that it must be recorded per
100,000 live births during the same time period of
the maternal mortality estimation, so the number of
mortalities during the past four years (10) was
multiplied by 100,000 then the product was divided
by the number of live births during the same four
years (13982) to get the accurate MMR which is
(71.52). While during 2004 MMR was found to be
13.1 in the United States. (4)
Also in table (1) it is evident that there is a
dangerous increase in the MMR since 2004, and
this is expected to be a direct result of the general
decline in the health care services since the
beginning of the invasion in 2003 (see graph (1) in
the appendix).

publications; 2007.
mortality. Statref
notes about maternal
Murad M. K. Statistical
In table (2) we can notice that most of the
mortality cases were among the urban mothers
(70%), and this may be due to the lifestyle and
physical activity differences that make the rural
resident mothers’ body build stronger and more
capable of child bearing than the urban mothers.
This finding differs slightly from a study
conducted in Jordan last year which stated that the
MMR is more or less the same between urban and
rural living mothers. (5)
Most of the mortality cases occur in the age
group below 20 years (60%), this is shown in table
(3), and can be explained physiologically and
anatomically by the incomplete maturation of the
mother’s uterus.

9
In table (4), it is interesting to note that the first
pregnancy is more dangerous and may lead to
mortality more often than the second or third
pregnancy (60%/40%) because the risk of mortality
will decrease in multigravida because of the
accommodation that takes place in the mother’s
body for child bearing.

Aafp web publications; 2003.

among pregnant women.
Valerie P., Brian W. Deaths
Causes of maternal mortality we found in our
work were mentioned in table (5) with their
frequencies, (see graph (2) I the appendix).
The most common cause of death was the uterine
bleeding (60%), followed by uterine rupture (30%)
then hypertension during pregnancy (10%).
These causes were almost the same as those
mentioned by a study conducted in Leon about the
same subject in 2002, which included in addition to
these some other rare causes like ovarian neuritis.(6)
At last, it should be mentioned that the final
result obtained about MMR (71.52) may be much
higher because of the unreliable registration system
that is found in our country, i.e. most of the
medical staff do not understand the exact meaning
of maternal mortality, and may explain it simply as
the death of the mother during labor. So the true
numbers may be much higher than those reported.

10
CONCLUSIONS
1. In general, the maternal mortality rate is too high (71.52).

2. The MMR is increasing since 2004.

3. Women under 20 years of age are more prone for

mortality.

4. The first pregnancy is more dangerous after 35 years of

age.

5. Urban women have a greater risk of maternal mortality

than rural resident women.

6. The most common cause of maternal mortality is uterine

bleeding (60%).

11
RECOMMENDATIONS
For families
1. Special care should be taken for pregnant women
under 20 years of age.
2. Good attention should be paid for women over 35
years of age undergoing their first pregnancy.
3. Any bleeding tendency or drug sensitivity must be
reported.

For IMoH
1. To educate the medical staff the exact and correct
meaning of maternal mortality.
2. To emphasize on the importance of statistical
recording of this subject.

12
REFERENCES
1. WHO. International classification of diseases.
Tenth revision. Geneva, WHO; 2004.
2. Miniño AM, Heron MP, Murphy SL,
Kochankek, KD. Deaths: Final Data for 2004.
National vital statistics reports; vol 55 no 19.
Hyattsville, MD: National Center for Health
Statistics. 2007.
3. A. Abdulraziq. Assessment of maternal mortality
in Alneel hospital. Statref publications; 2004.
4. T. A. Dalley. Important epidemiological data.
USA, Elsevier medical publications; 2006.
5. Murad M. K. Statistical notes about maternal
mortality. Statref publications; 2007.
6. Valerie P., Brian W. Deaths among pregnant
women. Aafp web publications; 2003.

13
APPENDIX

120 100.15
93.28
100
79.17
80

60
MMR
40

20 0
0
2004 2005 2006 2007

Graph (1): MMR in the past four years in TTH

10%
30% Uterine
bleeding
Ruptured
uterus
Hypertension
60%

Graph (2): Different causes of maternal mortality

14