What is the commonest cause of death in Pregnancy?

Pregnancy is actually a normal physiological condition. However, for it to remain normal throughout its duration, proper medical attention needs to be given to it. Unfortunately, this is not the case in many pregnancies because of the poor healthcare facilities and system in place. Hence, so many women die as a result of being pregnant.

When a woman dies while pregnant or within 6 weeks of terminating a pregnancy from any cause that is related to or worsened by that pregnancy or its management, it is called a maternal death. Preventing pregnancy-related deaths starts with a woman registering for and accessing antenatal care once her pregnancy test is positive. Moreover, it is important, as a pregnant woman or her relative, to be aware of the no. 1 cause of pregnancy-related death and the common symptoms it presents with.

Bleeding during pregnancy or within 6 weeks after delivery

This is the number one cause of death in pregnant women. If you notice any form of vaginal bleeding as a pregnant woman, especially after the 20th week (5 months), do not waste another second to quickly visit your doctor (obstetrician). There are three main conditions that give rise to bleeding during pregnancy, usually after the second trimester, or within 6 weeks after delivery.

  1. The first one (placenta abruptio) is due to the premature separation of the placenta from the wall of the womb. It presents with massive vaginal bleeding in which the blood is dark and contains clots; the woman’s uterus will also be stiff and painful. Sometimes, this particular condition may not present with any vaginal bleeding because the blood from the premature separation of the placenta accumulates within a space between the placenta and the wall of the womb. This is far more dangerous as the risk of death of the woman and her unborn baby is very high.
  2. The second condition (known as placenta previa) is due to the attachment of the placenta at the wrong site on the wall of the womb. In this case, the placenta is attached close to or over the opening (cervix) of the womb into the vagina. So any pressure at this site can cause a tearing away of part of the placenta, leading to bleeding. This condition presents with a minimal vaginal bleeding and there is usually no pain felt by the woman.

Some risk factors have been identified to contribute to the development of the above two conditions, and they include:

  • multiple pregnancy (a woman pregnant with twins or more)
  • a previous history of abortion
  • cigarette smoking in pregnancy
  • increasing age of the mother (a woman getting pregnant at 40 years and above)
  • a pregnant woman has already given birth to more than five children
  • a woman who has a genetic bleeding disorder (her blood doesn’t clot easily whenever she sustains an injury)
  • a woman who is hypertensive
  • a woman who develops hypertension after 20 weeks of pregnancy
  • a woman who has undergone a previous cesarean section

3. The third condition (postpartum haemorrhage) can occur anytime between immediately after birth and 6 weeks after delivery. So many things can cause this.

  • A woman whose uterus is not contracting powerfully enough may have this type of bleeding. This is because powerful contraction of the uterus during and after delivery of the baby and the placenta helps to control the normal bleeding that occurs during this period. And the uterus not contracting well enough can be due to it being overstretched by a big baby or a twin pregnancy; the labour being prolonged; the woman having given birth more than 5 times before her current pregnancy; a previous history of poor contraction of the uterus
  • normally, the placenta is delivered within 30 minutes after the baby has been delivered. However, during this process, some parts of the placenta may be retained, and this can lead to excessive bleeding within 6 weeks after delivery if not identified and managed immediately.
  • other pregnancy-related causes of bleeding within 6 weeks after delivery include injury to the woman’s reproductive tract during delivery. Hence, injury to the cervix or vagina or a rupture of the womb during childbirth can cause life-threatening bleeding if not repaired immediately

The danger of bleeding in pregnancy is not limited to the woman only. The unborn baby can die (stillbirth) from bleeding during pregnancy if the condition is not addressed immediately by an experienced obstetrician in a well-equipped hospital. If the baby survives, he or she may likely develop a brain abnormality such cerebral palsy, a condition in which the affected person has a problem with movement and may have learning disabilities.

Therefore, it is important for every pregnant woman to register for and receive antenatal care, be very observant and report any unusual experiences to her doctor (obstetrician); and after birth, the now nursing mother should continue to be observant and ensure she attends postnatal clinic as at when due. Doing this will significantly cut down the chances of any pregnant woman and her unborn baby dying or developing any health issue as a result of pregnancy.

For more advice and help, feel free to ask a Doctor via The Reliance Care App.

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