World Health Organization (2013). Maternal Mortality.

http://www.who.int/mediacentre/factsheets/fs348/en/. Diakses 6 Mei 2014

Maternal mortality
Fact sheet N348
Updated May 2014

Key facts

Every day, approximately 800 women die from preventable causes related to pregnancy
and childbirth.

99% of all maternal deaths occur in developing countries.

Maternal mortality is higher in women living in rural areas and among poorer
communities.

Young adolescents face a higher risk of complications and death as a result of pregnancy
than older women.

Skilled care before, during and after childbirth can save the lives of women and newborn
babies.

Between 1990 and 2013, maternal mortality worldwide dropped by almost 50%.

Maternal mortality is unacceptably high. About 800 women die from pregnancy- or childbirthrelated complications around the world every day. In 2013, 289 000 women died during and
following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings,
and most could have been prevented.
Progress towards achieving the fifth Millennium Development Goal
Improving maternal health is 1 of the 8 Millennium Development Goals (MDGs) adopted by the
international community in 2000. Under MDG5, countries committed to reducing maternal
mortality by three quarters between 1990 and 2015. Since 1990, maternal deaths worldwide have
dropped by 45%.

In sub-Saharan Africa, a number of countries have halved their levels of maternal mortality since
1990. In other regions, including Asia and North Africa, even greater headway has been made.
However, between 1990 and 2013, the global maternal mortality ratio (i.e. the number of
maternal deaths per 100 000 live births) declined by only 2.6% per year. This is far from the
annual decline of 5.5% required to achieve MDG5.
Where do maternal deaths occur?
The high number of maternal deaths in some areas of the world reflects inequities in access to
health services, and highlights the gap between rich and poor. Almost all maternal deaths (99%)
occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and
almost one third occur in South Asia.
The maternal mortality ratio in developing countries in 2013 is 230 per 100 000 live births versus
16 per 100 000 live births in developed countries. There are large disparities between countries,
with few countries having extremely high maternal mortality ratios around 1000 per 100 000 live
births. There are also large disparities within countries, between women with high and low
income and between women living in rural and urban areas.
The risk of maternal mortality is highest for adolescent girls under 15 years old and
complications in pregnancy and childbirth are the leading cause of death among adolescent girls
in developing countries.1, 2
Women in developing countries have on average many more pregnancies than women in
developed countries, and their lifetime risk of death due to pregnancy is higher. A womans
lifetime risk of maternal death the probability that a 15 year old woman will eventually die
from a maternal cause is 1 in 3700 in developed countries, versus 1 in 160 in developing
countries.
Why do women die?
Women die as a result of complications during and following pregnancy and childbirth. Most of
these complications develop during pregnancy. Other complications may exist before pregnancy
but are worsened during pregnancy. The major complications that account for nearly 75% of all
maternal deaths are:3

severe bleeding (mostly bleeding after childbirth)

infections (usually after childbirth)

high blood pressure during pregnancy (pre-eclampsia and eclampsia)

complications from delivery

unsafe abortion.

The remainder are caused by or associated with diseases such as malaria, and AIDS during
pregnancy.
Maternal health and newborn health are closely linked. Almost 3 million newborn babies die
every year4, and an additional 2.6 million babies are stillborn.5
How can womens lives be saved?
Most maternal deaths are preventable, as the health-care solutions to prevent or manage
complications are well known. All women need access to antenatal care in pregnancy, skilled
care during childbirth, and care and support in the weeks after childbirth. It is particularly
important that all births are attended by skilled health professionals, as timely management and
treatment can make the difference between life and death.
Severe bleeding after birth can kill a healthy woman within hours if she is unattended. Injecting
oxytocin immediately after childbirth effectively reduces the risk of bleeding.
Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of
infection are recognized and treated in a timely manner.
Pre-eclampsia should be detected and appropriately managed before the onset of convulsions
(eclampsia) and other life-threatening complications. Administering drugs such as magnesium
sulfate for pre-eclampsia can lower a womans risk of developing eclampsia.

To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All
women, including adolescents, need access to contraception, safe abortion services to the full
extent of the law, and quality post-abortion care.
Why do women not get the care they need?
Poor women in remote areas are the least likely to receive adequate health care. This is especially
true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and
South Asia. While levels of antenatal care have increased in many parts of the world during the
past decade, only 46% of women in low-income countries benefit from skilled care during
childbirth6. This means that millions of births are not assisted by a midwife, a doctor or a trained
nurse.
In high-income countries, virtually all women have at least 4 antenatal care visits, are attended
by a skilled health worker during childbirth and receive postpartum care. In low-income
countries, just over a third of all pregnant women have the recommended 4 antenatal care visits.
Other factors that prevent women from receiving or seeking care during pregnancy and
childbirth are:

poverty

distance

lack of information

inadequate services

cultural practices.

To improve maternal health, barriers that limit access to quality maternal health services must be
identified and addressed at all levels of the health system.
WHO response
Improving maternal health is one of WHOs key priorities. WHO is working to reduce maternal
mortality by providing evidence-based clinical and programmatic guidance, setting global
standards, and providing technical support to Member States.
In addition, WHO advocates for more affordable and effective treatments, designs training
materials and guidelines for health workers, and supports countries to implement policies and
programmes and monitor progress.
During the United Nations MDG summit in September 2010, UN Secretary-General Ban Kimoon launched a Global strategy for women's and children's health, aimed at saving the lives of

more than 16 million women and children over the next 4 years. WHO is working with partners
towards this goal7.

Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality

associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal
of Obstetrics and Gynecology, 2004, 192:342349.
2

Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers
CD. Global patterns of mortality in young people: a systematic analysis of population health
data. Lancet, 2009, 374:881892.
3

Say L et al. Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet. 2014.

UNICEF, WHO, The World Bank, United Nations Population Division. The Inter-agency
Group for Child Mortality Estimation (UN IGME). Levels and Trends in Child Mortality. Report
2013. New York, USA, UNICEF, 2013.
5

Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunalp O,

Balsara ZP, Gupta S, Say L, Lawn JE. National, regional, and worldwide estimates of stillbirth
rates in 2009 with trends since 1995: a systematic analysis. Lancet, 2011, Apr 16,
377(9774):1319-30. [in press, will be published 15 May 2014]
6

WHO. World Health Statistics 2014. Geneva, World Health Organization; 2014.

Ban K. The Global Strategy for Womens and Childrens Health. New York, NY, USA, United
Nations, 2010.
For more information contact:

WHO Media centre

Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

Kee HL, Guy S, Ramus RM, Barnes AD, Dyve PL, Erogul M, et al. Preeclampsia.
http://emedicine.medscape.com/article/1476919-overview#aw2aab6b3.

Diakses

18

September 2013.

Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that
occurs after 20 weeks' gestation and can present as late as 4-6 weeks postpartum. It is clinically
defined by hypertension and proteinuria, with or without pathologic edema.
The incidence of preeclampsia in the United States is estimated to range from 2% to 6% in
healthy, nulliparous women.[7, 8, 9] Among all cases of the preeclampsia, 10% occur in pregnancies
of less than 34 weeks' gestation. The global incidence of preeclampsia has been estimated at 514% of all pregnancies.
In developing nations, the incidence of the disease is reported to be 4-18%,[10, 11] with
hypertensive disorders being the second most common obstetric cause of stillbirths and early
neonatal deaths in these countries.[12]
Medical consensus is lacking regarding the values that define preeclampsia, but reasonable
criteria in a woman who was normotensive before 20 weeks' gestation include a systolic blood
pressure (SBP) greater than 140 mm Hg and a diastolic BP (DBP) greater than 90 mm Hg on 2
successive measurements, 4-6 hours apart. Preeclampsia in a patient with preexisting essential
hypertension is diagnosed if SBP has increased by 30 mm Hg or if DBP has increased by 15 mm
Hg.
Mild and severe preeclampsia

Preeclampsia is mild in 75% of cases and severe in 25% of them.[6] In its extreme, the disease
may lead to liver and renal failure, disseminated intravascular coagulopathy (DIC), and central
nervous system (CNS) abnormalities. If preeclampsia-associated seizures develop, the disorder
has developed into the condition called eclampsia.
Mild preeclampsia is defined as the presence of hypertension (BP 140/90 mm Hg) on 2
occasions, at least 6 hours apart, but without evidence of end-organ damage in the patient.
Severe preeclampsia is defined as the presence of 1 of the following symptoms or signs in the
presence of preeclampsia:

SBP of 160 mm Hg or higher or DBP of 110 mm Hg or higher on 2 occasions

at least 6 hours apart

Proteinuria of more than 5 g in a 24-hour collection or more than 3+ on 2

random urine samples collected at least 4 hours apart

Pulmonary edema or cyanosis

Oliguria (< 400 mL in 24 h)

Persistent headaches

Epigastric pain and/or impaired liver function

Thrombocytopenia

Oligohydramnios, decreased fetal growth, or placental abruption

Classification and characteristics of hypertensive disorders

Preeclampsia is part of a spectrum of hypertensive disorders that complicate pregnancy. As

specified by the National High Blood Pressure Education Program (NHBPEP) Working Group,
the classification is as follows[13] :

Gestational hypertension

Chronic hypertension

Preeclampsia/eclampsia

Superimposed preeclampsia (on chronic hypertension)

Although each of these disorders can appear in isolation, they are thought of as progressive
manifestations of a single process and are believed to share a common etiology.
Gestational hypertension

The characteristics of gestational hypertension are as follows:

BP of 140/90 mm Hg or greater for the first time during pregnancy

No proteinuria

BP returns to normal less than 12 weeks' postpartum

Final diagnosis made only postpartum

Chronic hypertension

Chronic hypertension is characterized by either (1) a BP 140/90 mm Hg or greater before

pregnancy or diagnosed before 20 weeks' gestation; not attributable to gestational trophoblastic
disease or (2) hypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks
postpartum.
Preexisting chronic hypertension may present with superimposed preeclampsia presenting as
new-onset proteinuria after 20 weeks' gestation.
Preeclampsia/eclampsia

Preeclampsia/eclampsia is characterized by a BP of 140/90 mm Hg or greater after 20 weeks'

gestation in a women with previously normal BP and who have proteinuria (0.3 g protein in 24h urine specimen).
Eclampsia is defined as seizures that cannot be attributable to other causes, in a woman with
preeclampsia
Superimposed preeclampsia

Superimposed preeclampsia (on chronic hypertension) is characterized by (1) new onset

proteinuria (300 mg/24 h) in a woman with hypertension but no proteinuria before 20 weeks'
gestation and (2) a sudden increase in proteinuria or BP, or a platelet count of less than
100,000/mm3, in a woman with hypertension and proteinuria before 20 weeks' gestation.
HELLP syndrome

HELLP syndrome (hemolysis, elevated liver enzyme, low platelets) may be an outcome of
severe preeclampsia, although some authors believe it to have an unrelated etiology. The
syndrome has been associated with particularly high maternal and perinatal morbidity and
mortality rates and may be present without hypertension or, in some cases, without proteinuria.
Proteinuria

Proteinuria is defined as the presence of at least 300 mg of protein in a 24-hour urine collection.
Some investigators and clinicians have accepted a urine protein-creatinine ratio of at least 0.3 as
a criterion for proteinuria, but the American College of Obstetricians and Gynecologists (ACOG)
has not yet incorporated this into their definition.[14] In the emergency department, a urine
protein-to-creatinine ratio of 0.19 or greater is somewhat predictive of significant proteinuria
(negative predictive value [NPV], 87%).[15] Serial confirmations 6 hours apart increase the
predictive value. Although more convenient, a urine dipstick value of 1+ or more (30 mg/dL) is
not reliable in the diagnosis of proteinuria.

Kesgakepri

(2010).

Angka

Kematian

Ibu

(AKI)

di

Provinsi

Kepulauan

Riau.

http://kesgakepri.com/2010/09/21/angka-kematian-ibu-aki-2/. Diakses 21 September 2010.

Angka Kematian Ibu (AKI)

Posted by kesgakepri pada 21 September 2010
Angka kematian ibu (AKI) atau Maternal Mortality Rate (MMR), tidak hanya merupakan
indikator tingkat kesehatan wanita, tetapi juga dapat lebih jelas menggambarkan tingkat akses,
integritas, dan efektivitas sektor kesehatan. Oleh karena itu, MMR juga sering digunakan sebagai
indikator tingkat kesejahteraan dari suatu daerah/Negara.
Berbicara mengenai Angka Kematian Ibu (AKI) sudah semestinya kita mencontoh Negaranegara tetangga seperti Malaysia dan Singapura dimana angka kematian dari Negara-negara
tersebut dapat dikatakan sangat rendah, sedangkan angaka kematian dinegara kita masih jauh
diatasnya.
Sehubungan dengan upaya pencapaian Indonesia sehat 2010 telah di targetkan penurunan AKI
menjadi 125/100.000 kelahiran hidup. Adapun jumlah kematian ibu di Provinsi Kepulauan Riau
pada tahun 2009 sebanyak 34 kasus atau secara kasar AKI di Provinsi Kepulauan Riau sebesar
84/100.000 kelahiran hidup. Berdasarkan laporan tahunan dari Dinas Kesehatan Kabupaten/Kota
dan di perkuat oleh upaya validasi data dan review kematian dapat diketahui penyebab terbanyak
dari kematian tersebut adalah perdarahan. Jika kita melihat data tahun 2008 dan tahun 2009,
Kota Batam belum beranjak menempati posisi jumlah kematian ibu terbanyak, yaitu sebesar 10
kasus. Untuk dapat lebih jelasnya mengenai jumlah dan sebab kematian ibu dimasing-masing
Kabupaten/Kota, dapat dilihat dari grafik di bawah ini :

Jumlah Kematian Ibu Berdasarkan Penyebab Di Provinsi Kepulauan Riau Tahun 2009

Sumber : Validasi Data F1-F8 Provinsi Kepulauan Riau Tahun 2009

Dari grafik diatas dapat dilihat bahwa jumlah kematian ibu terbanyak terdapat di Kota Batam
yaitu sebanyak 10 kasus kematian ibu, dengan penyebab kematian paling banyak adalah
Perdarahan. Banyak nya jumlah kematian di Kota Batam dikarenakan besarnya jumlah penduduk
yang berada disana (lebih dari separuh penduduk Kepulauan Riau berdomisili di Kota Batam).
Kematian ibu juga terjadi di Kabupaten lain yang juga disebabkan oleh perdarahan, hipertensi
dalam kehamilan, dan lain-lain. Sementara di Kabupaten Kepulauan Anambas tidak terdapat
kematian ibu.
Sedangkan untuk persentase penyebab kematian ibu terbesar dapat dilihat pada grafik 4.5 di
bawah ini :

Grafik 4.5 Persentase Kematian Ibu Berdasarkan Penyebab Di Provinsi Kepulauan Riau
Tahun 2009
Sumber : Validasi Data F1-F8 Provinsi Kepulauan Riau Tahun 2009
Dari grafik di atas dapat dilihat bahwa penyebab kematian ibu yang terbesar di Provinsi
Kepulauan Riau pada tahun 2009 masih di dominasi oleh perdarahan sebesar 33%. Hipertensi
dalam kehamilan, infeksi, dan lainnya juga merupakan penyebab kematian ibu. Berbeda dari
tahun sebelumnya jumlah kematian ibu yang terbanyak disebabkan oleh hipertensi dalam
kehamilan.