Hemorrhage leading cause of maternal mortality

CEBU, Philippines - Severe blood loss during labor is the leading cause of death among pregnant women, the Philippine Obstetrical and Gynecologic Society-Cebu Chapter disclosed yesterday. 

This excessive bleeding, which is also known as obstetrical hemorrhage, refers to heavy bleeding during pregnancy, labor, or delivery. Bleeding may be vaginal and external, or, less commonly but more dangerously, internal, into the abdominal cavity.

POGS-7 director Dr. Charisse Espina-Tan said a total of 130 deaths in 176,000 livebirths or 74 per 100,000 livebirths were recorded in Central Visayas.

Tan said 60 percent of this or 78 deaths occurred in Cebu province. She added that 21 percent of the maternal mortality rate was due to hemorrhage secondary to hypertension.

But for institutional deliveries, the Committee on Maternal and Fetal Welfare of POGS data showed that at least 134 women died last year during delivery in 16 hospitals in Cebu. 

Dr. Lorna Diorico, chairman of the CMFW-POGS, said 34.6 percent or 46 of the 134 maternal deaths was due to direct obstetric causes (DOC), including hemorrhage.

Obstetrician and gynecologist Dr. Marivic Tan, POGS public relations officer, said around 25-30 percent of maternal mortality worldwide, reaching as high as 60 percent in some countries, is attributed to obstetrical hemorrhage.

The reasons for severe bleeding during and after the third stage of labor are uterine atony (failure of the uterus to contract properly after delivery); trauma (cervical, vaginal, or perineal lacerations); retained or adherent placental tissue; clotting disorders; and inverted or ruptured uterus. 

Citing the World Health Organizations, Tan said at least 839 women die everyday from preventable causes related to pregnancy and childbirth. Around 90 percent of these maternal deaths occur in developing countries like the Philippines, which ranked 74th in 2014 among 184 countries surveyed with the highest rate of maternal mortality. 

To prevent maternal death from obstetrical hemorrhage, Tan said the patient needs transfusion of ample amount of blood to replace what was lost during childbirth and to restore hemodynamic stability.

The procurement of blood, however, is not easily accessible and readily affordable for poor women. One bag of blood costs around P5,000 in government hospital, the amount double or triple in private hospitals.

 Campaign

The country reportedly failed to reach the Millennium Development Goal last year of reducing its maternal mortality to 52 from 162 per 100,000 mothers.

Under MDGs, countries are committed to reducing maternal mortality from 1990-2015. Unfortunately, since 1990, maternal deaths had dropped to only 43 percent worldwide. 

DOH has identified at least three contributing factors – delay in reaching appropriate centers, delay in providing health, and delay in seeking medical help.

The MDG5 target has transitioned into Sustainable Development Goal 3, aiming to reduce global maternal mortality ratio to less than 70 per 100,000 births.

Dr. Virginia Abalos, POGS-Cebu president, attributed the number of maternal mortality to high incidence of poverty; high incidence of gender inequality in areas where women are not given importance; and lack of access to maternal facility; among others.

“We know what to do to battle this. But, our hands are tight in terms of beyond us. We are trying to reduce maternal mortality by looking at the problem, hemorrhage, infection and hypertension,” she said, adding that this is a wake-up call for everybody to contribute in mitigating or lowering maternal deaths.

In its continuing efforts to improve maternal health and help achieve the SDG-3, POGS-Cebu Chapter has intensified its campaign to battle and somehow lessen the maternal deaths through “Save a Mother from Hemorrhage” project. This was launched in 2003 during the stint of Dr. Ellen Chavez. 

The project aims for widespread awareness on maternal mortality from obstetrical hemorrhage as well as raise funds for the procurement of blood. 

The blood will be provided for free to indigent women suffering from excessive bleeding during pregnancy or childbirth in government hospitals. — (FREEMAN)