Maternal mortality rate is steadily declining in India, says UK doctor

"Indian MMR is declining, steadily but slowly," said Dr. Jean McEwan, Professor of Clinical Education and Consultant Cardiologist, Royal Devon & Exeter Hospital, UK.

Maternal Mortality Rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).

While talking about maternal mortality in the UK, Dr Jean said that in 2011-2013, nine of per 100,000 women died up to six weeks after giving birth or the end of the pregnancy and 14 more women of per 100,000 died between six weeks and a year after their pregnancy.

"Almost a quarter of women died between six weeks and one year after pregnancy died from mental-health related causes in 2011-2013, while 1 in 7 women died by suicide," she   said, basing on a study report, published in 2015 by independent health related issues monitoring collaboration MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK).

"The study report explains that cardiac disease is the commonest indirect cause of maternal death in UK, while Pulmonary Thromboembolism directly causes maternal death," Dr Jean McEwan added.

Talking about maternal death in India, the senior cardiologist said, "According to a review of 124 deaths published in 2014, 23.4%, 17.7%, 4.8% and 14% maternity deaths were caused in India due to Postpartum Haemorrhage, Anaemia, Antepartum Haemorrhage and severe Pre-eclampsia or eclampsia respectively."

Professor Jean also said that Rheumatic Mitral Stenosis was the single most common cause of cardiac maternal mortality in the developing world.

"For early diagnosis and treatment, diuretics during pregnancy is very important for those, who have heart problem(s)," she added.

Meanwhile, another UK-based Nephrologist, Sunil Bhandari, said that Hypertension was another most common problem encountered during pregnancy.

"Nearly 8% of pregnancy in India may suffer hypertension. Gestational Hypertension or Pregnancy-Induced Hypertension (PIH), which is the development of new hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine, could be assumed only after twenty weeks of pregnancy," Consultant Nephrologist of UK's Hull & East Yorkshire NHS Hospitals, Sunil Bhandari, said.

According to the senior doctor, headache (classically severe) is the effects of hypertension and vasospasm, while visual disturbances (flashing lights) are the sign of cerebral vasospasm or impending eclampsia.

Kolkata-based Gastroenterologist, Asokananda Konar, said that infections due to Hepatitis B in pregnancy was another major challenge. 

"Nearly 350 million people are carrying Hepatitis B Virus (HBV) worldwide. Possibility of Hepatitis B transmission from mother to child is really high. Mother-To-Child-Transmision (MTCT) rates for Hepatitis B Surface Antigen Positive (HBsAG +) and HBsAG Negative (-) are 70-90% and 10-40% respectively," Asokananda Konar, Consultant Gastroenterologist of Kolkata's Peerless Hospital and B K Roy Research Centre, said.

The specialist said that HBV could be transferred via vertical and horizontal routes and rates of Chronic Hepatitis B (CHB) infection were 90% for the infants and 50% for the toddlers and young children (aged between 1-5 years).

"Hepatitis B infection during pregnancy transfers the virus to next generation and MTCT rate can be reduced by 1.4% using Elective Caesarean Section (CS) method, 3.4% by Vaginal Delivery and 4.2% by Emergency CS," Dr. Konar added.

The doctor also suggested for a Hepatitis B test during pregnancy to avoid the MTCT and recommended the CHB positive (+) mothers not to use antiviral during breastfeeding. .

UK-based Metabolic Medicine's professor Rebecca Reynolds said that Gestational Diabetes Mellitus (GDM), any degree of glucose intolerance with onset or first recognition during pregnancy, could create problems for mothers and their babies.

Talking about Gestational Diabetes, Metabolic Medicine's professor of UK's University of Edinburgh, Rebecca Reynolds, said, "GDM results short term problems for mothers, including medicalised pregnancy, frequent hospital visits and potential assisted/instrumental delivery, and also for babies, including Macrosomia, Shoulder Dystocia, Neonatal Hypoglycaemia and potential early delivery."

"GDM can create long term consequences for both mother and baby, including risk of obesity, diabetes and CVD (Cardiovascular Disease)," she added.

However, the professor said that the pathway of care to avoid GDM were proper diagnosis, home glucose monitoring and controlled lifestyle during pregnancy.

With an aim to spreading the education to junior doctors and share experiences with them, Peerless Hospital, B. K. Roy Foundation and Royal College of Physicians of Edinburgh jointly hosted the third edition of Medicon International conference in Kolkata's Hyatt Regency hotel. The two-day long event was held on Saturday (December 17) and Sunday (December 18).