Direct Obstetric Causes Research Articles

Maternal death before admission to the Sylvanus Olympia University Hospital Center (CHU SO) epidemiological and etiological aspects

Objective: determine the epidemiological and etiological profiles of a pregnant, parturient or women given birth before or within 10 minutes of admission Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study. Of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: in total, 654 maternal deaths including 153 maternal deaths before admission were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum; 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel; 46.3% referred without a reference form, 94.3% were referred without a venous access. In 10.7% the reason for evacuation was bleeding from the delivery with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: deaths before admission constitute an increasingly growing problem at CHU SO. Late referral is a determining factor in maternal deaths before admission.

Perfil epidemiológico, sobrevida e prognóstico materno em unidade de terapia intensiva no nordeste do Brasil

Objective. To study the epidemiologic profile and determine maternal survival and prognosis in an Intensive Care Unit (ICU) in the Northeast of the country. Methods. Analytical cross-sectional design study that evaluated pregnant women, puerperae, and women in postabortion or ectopic pregnancy admitted to an obstetric ICU in Teresina between May/2016 and May/2017. Results. Of the 11,466 occurrences in the period, 456 women were admitted to the ICU. Among the causes of hospitalization, 80.3% patients were direct obstetric causes, 16.2% indirect and 3.5% non-obstetric. A total of 159 patients met the Near Miss criteria, with statistical significance between presentation of the criteria and mortality (p<0.001; x²=30.974). The mortality rate was 3.5%, all of them being Near Miss cases. There was a statistically significant and direct correlation between survival and number of clinical (p<0.001; rp=0.270), laboratory (p<0.001; rp=0.358) and management (p<0.001; rp=0.465) criteria. It was identified that the higher the number of criteria, the longer the length of hospitalization and worse the prognosis (p<0.001). Conclusion. Women admitted to the ICU for indirect obstetric causes who met maternal Near Miss criteria had longer hospitalization and worse prognosis.

Obstetric violence: socioeconomic and ethnics disparities in brazilian territory

As a country with a history of racial exploitation, aspects of colonial relationships persist in modern healthcare. The institutionalization of obstetric violence reflects structural racism, leading to the dehumanization of non-white women and the submission of birthing individuals to a paternalistic medical figure. The objective is to elucidate racial and social inequities in obstetric violence rates in Brazil. This literature review is restricted to the last five years, covering four databases, with the selection of 13 articles following exclusion criteria. There is a high maternal-fetal mortality rate due to direct obstetric causes, associated with increased rates of iatrogenic interventions and physical and verbal violence during childbirth. Resistance from the medical community, coupled with elitism in leadership positions of movements against obstetric violence and the normalization of abuses, makes it challenging for black women to recognize the violence. It is mandatory to implement legislation directly prohibiting obstetric violence.

Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?

National Vital Statistics System reports show that maternal mortality rates in the United States have nearly doubled, from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. However, these high and rising rates could reflect issues unrelated to obstetrical factors, such as changes in maternal medical conditions or maternal mortality surveillance (eg, due to introduction of the pregnancy checkbox). This study aimed to assess if the high and rising rates of maternal mortality in the United States reflect changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance. The study was based on all deaths in the United States from 1999 to 2021. Maternal deaths were identified using the following 2 approaches: (1) per National Vital Statistics System methodology, as deaths in pregnancy or in the postpartum period, including deaths identified solely because of a positive pregnancy checkbox, and (2) under an alternative formulation, as deaths in pregnancy or in the postpartum period, with at least 1 mention of pregnancy among the multiple causes of death on the death certificate. The frequencies of major cause-of-death categories among deaths of female patients aged 15 to 44 years, maternal deaths, deaths due to obstetrical causes (ie, direct obstetrical deaths), and deaths due to maternal medical conditions aggravated by pregnancy or its management (ie, indirect obstetrical deaths) were quantified. Maternal deaths, per National Vital Statistics System methodology, increased by 144% (95% confidence interval, 130-159) from 9.65 in 1999-2002 (n=1550) to 23.6 per 100,000 live births in 2018-2021 (n=3489), with increases occurring among all race and ethnicity groups. Direct obstetrical deaths increased from 8.41 in 1999-2002 to 14.1 per 100,000 live births in 2018-2021, whereas indirect obstetrical deaths increased from 1.24 to 9.41 per 100,000 live births: 38% of direct obstetrical deaths and 87% of indirect obstetrical deaths in 2018-2021 were identified because of a positive pregnancy checkbox. The pregnancy checkbox was associated with increases in less specific and incidental causes of death. For example, maternal deaths with malignant neoplasms listed as a multiple cause of death increased 46-fold from 0.03 in 1999-2002 to 1.42 per 100,000 live births in 2018-2021. Under the alternative formulation, the maternal mortality rate was 10.2 in 1999-2002 and 10.4 per 100,000 live births in 2018-2021; deaths from direct obstetrical causes decreased from 7.05 to 5.82 per 100,000 live births. Deaths due to preeclampsia, eclampsia, postpartum hemorrhage, puerperal sepsis, venous complications, and embolism decreased, whereas deaths due to adherent placenta, renal and unspecified causes, cardiomyopathy, and preexisting hypertension increased. Maternal mortality increased among non-Hispanic White women and decreased among non-Hispanic Black and Hispanic women. However, rates were disproportionately higher among non-Hispanic Black women, with large disparities evident in several causes of death (eg, cardiomyopathy). The high and rising rates of maternal mortality in the United States are a consequence of changes in maternal mortality surveillance, with reliance on the pregnancy checkbox leading to an increase in misclassified maternal deaths. Identifying maternal deaths by requiring mention of pregnancy among the multiple causes of death shows lower, stable maternal mortality rates and declines in maternal deaths from direct obstetrical causes.

Effects of emerging SARS-CoV-2 on total and cause-specific maternal mortality: A natural experiment in Chile during the peak of the outbreak, 2020-2021.

This study estimated the effects of the COVID-19 pandemic on maternal mortality in Chile between 2020 and 2021. A natural experiment was conducted using official data on maternal deaths and live births (LBs) between 1997 and 2021. The effects of the SARS-CoV-2 outbreak were evaluated using interrupted time series (ITS) and an autoregressive integrated moving average (ARIMA) model to forecast the expected rates on MMR and 95% confidence intervals (95% CI). In Chile, following World Health Organization suggestions, maternal deaths aggravated by SARS-CoV-2 are assigned to code O98.5 (non-respiratory infectious indirect) accompanied by code U07.1 or U07.2, depending on confirmation of the presence or absence of the virus. ITS analysis revealed that the SARS-CoV-2 outbreak impacted the MMR due to indirect causes, with a greater increase in indirect nonrespiratory causes than respiratory causes. The ARIMA forecast was consistent with ITS, showing that the expected MMR for indirect causes (3.44 in 2020 and 1.55 in 2021) was substantially lower than the observed rates (9.65 in 2020 and 7.46/100.000 LBs in 2021). For nonrespiratory indirect causes, the observed values of the MMR for 2020 (8.77/100.000 LBs) and 2021 (7.46/100.000 LBs) were double the predicted values of 4.02 (95% CI: 0.44-7.61) and 3.83 (95% CI: -0.12-7.79), respectively. A lower effect was observed on direct obstetrical deaths. During 2020-2021, there was a rise in the MMR in Chile attributable to SARS-CoV-2. The pandemic contributed to an escalation in the MMR due to indirect causes, particularly nonrespiratory and infectious causes. MMR due to direct obstetric causes were less affected. This suggests that the pandemic disproportionately affected maternal health by exacerbating conditions unrelated to pregnancy, childbirth, or postpartum, more than those directly linked to obstetric complications.

MATERNAL DEATH REVIEWS: A RETROSPECTIVE CASE SERIES OF REPORTED CASES IN SABAH, MALAYSIAN BORNEO FROM 2015-2020

Women's life expectancy in Sabah for 2010 was 78.3 years, declining by 2.3 years to 76 years in 2020. Women's life expectancy is intrinsically linked to maternal and child health. All other states in Malaysia recorded rising life expectancies for both women and men except for Sabah, which is the country's poorest state with the highest non-citizen population. This study aimed to understand the demography, case characteristics and causes of maternal mortality in Sabah from 2015 through 2020. Data analyses were performed using Microsoft Excel. A total of 371 maternal deaths were reviewed. The mean age of the women who died was 30 years, and the majority (20.2%) were gravida 2. 72.78% were non-citizens of Malaysia, with 26.95% Malaysian citizens. Majority of deceased women, 56.7%, never attended antenatal visits prior to their death in the latest pregnancy. Overall, 63.88% deaths were due to direct obstetric causes, postpartum haemorrhage was the leading direct cause of death (24.53%), and most of the maternal deaths (65.5%) were preventable. There is evidence that further emphasized the importance of increasing access towards quality antenatal care and skilled birth attendants during delivery, especially for non-citizens of Malaysia. This which calls for intersectoral collaboration to ensure affordable, quality antenatal, delivery and family planning services for non-citizens of Malaysia. Increasing health promotion regarding the importance of attending antenatal visits is imperative to reduce maternal deaths.

Determinants of Maternal Mortality at The Tambacounda Regional Hospital Centre

Objectives: The objective of this study was to analyse the determinants of maternal mortality in the gynaecology-obstetrics department of the Tambacounda Regional Hospital Centre (RHC). Methodology: This was a retrospective, descriptive and analytical study of all obstetric admissions. A questionnaire was used to collect the data, which were then entered and analysed using Epi info 7.2.2.6 software. Results: Forty-one cases of maternal death were found, representing 6.3% of cases. Direct obstetrical causes represented most causes of death, i.e., 70.7% of cases and were dominated by haemorrhage (26.8%). Indirect obstetric causes were dominated by severe anaemia, accounting for 24.4% of cases and representing the second most common cause of maternal death in our study. Multivariate analysis using the logistic regression model identified two factors statistically associated with maternal deaths. These were the number of antenatal visits made, ANC (OR = 0.70 [0.52 - 0.96]; p = 0.0253) and admission to intensive care (OR = 12.03 [5.31- 27.25]; p = 0.0000). Conclusion: Maternal mortality in the Tambacounda region remains high although efforts have been made to reduce it. Different risk factors associated with maternal mortality were identified in our study. It is therefore necessary that actions be taken by acting on these different factors in order to reduce maternal mortality.

Nonobstetric Maternal Mortality Trends by Race in the United States From 2000 to 2019 [ID: 1376551

INTRODUCTION: Public health interventions to reduce maternal mortality have focused on direct and indirect obstetric causes, while neglecting nonobstetric causes of death. The study objective was to examine recent trends in maternal deaths from nonobstetric causes in the United States. METHODS: A population-based cross-sectional study was conducted in the United States using data from the “Birth Data” and “Mortality Multiple Cause” files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to nonobstetric causes per 100,00 live births were calculated across racial groups using official death certificates, while the effects of race on the risk of nonobstetric maternal mortality and temporal changes over the study period were examined using logistic regression models. RESULTS: From 2000 to 2019, a total of 7,334 women died during pregnancy and childbirth from nonobstetric causes, where 31.3% of these deaths were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to be at the highest risk of nonobstetric maternal mortality (odds ratio 2.20, 95% CI 1.90–2.56), and 46.1% of all deaths among pregnant American Indian women were caused by nonobstetric complications. The risk of nonobstetric maternal mortality increased overall during the study period, with a greater increase among Black (1.15, 1.13–1.17) and American Indian women (1.17, 1.13–1.21). CONCLUSION: Nonobstetric causes of death have become increasingly prevalent in the United States, overall and especially in American Indian women. Novel interventions to address these nonobstetric factors should especially target American Indian women to improve maternal outcomes.

Levels and trends of maternal death in Baoan district, Shenzhen, China, 1999–2022

China had achieved impressive success in improving maternal health, while the progress of reducing maternal mortality ratio (MMR) varied across regions. Some studies had reported maternal mortality from national or provincial perspective, but researches of the MMR on long-term period at the city or county level rare been reported. Shenzhen has experienced significant socioeconomic and health changes, reflecting the typical development of China's coastal city. This study mainly introduced the levels and trends of maternal death in Baoan district, Shenzhen from 1999 to 2022. Maternal mortality data were extracted from registration forms and the Shenzhen Maternal and Child Health Management System. Linear-by-Linear Association tests were used to evaluate the trends of MMR among different groups. The study periods were divided into three stages by 8-year interval and χ2 test or Fisher's test was used to test the difference in maternal deaths of different periods. During 1999-2022, a total of 137 maternal deaths occurred in Baoan, the overall MMR was 15.91 per 100,000 live births, declined by 89.31% with an annualized rate of 9.26%. The MMR declined by 68.15% in migrant population, with an annualized rate of 5.07%, faster than that in permanent population (48.73%, 2.86%). The MMR due to direct and indirect obstetric causes shown a downward trend (P<0.001) and the gap between them narrowed to 14.29% during 2015-2022. The major causes of maternal deaths were obstetric hemorrhage (4.41 per 100,000 live births), amniotic fluid embolism (3.37 per 100,000 live births), medical complications (2.44 per 100,000 live births) and pregnancy-induced hypertension (1.97 per 100,000 live births), the MMR due to the above causes all shown decreasing trends (P < 0.01), pregnancy-induced hypertension became the leading cause of deaths during 2015-2022. The constituent ratio of maternal deaths with advanced age significantly increased by 57.78% in 2015-2022 compared with in 1999-2006. Baoan district had made encouraging progress in improving maternal survival, especially in migrant population. To further reduce the MMR, strengthening professional training to improve the capacity of obstetricians and physicians, increasing the awareness and ability of self-help health care among elderly pregnant women were in urgent need.

MATERNAL DEATHS IN PUNJAB: A 3-YEAR AUDIT FROM A TERTIARY LEVEL GOVERNMENT INSTITUTE

Objective: This study aims to recognize the most common causes and delays in maternal death. Methods: This is an observational study from Government Medical College Amritsar from the period December 2017 to November 2020 which included all cases of maternal death irrespective of gestational age and up to 42 days postpartum. Results: Maternal mortality ratio in our institute during 3-year study period (2018–2020) was 1081 per 100,000 live births. About 90.9% of the maternal deaths were unregistered emergency cases, 11.7% were brought dead, and 33.8% deaths took place within 24 h of admission. Direct obstetric causes were the most common causes of maternal death (49%), while indirect causes were responsible for 42.8% deaths. Hypertensive disorders and hemorrhage were responsible for almost one third cases and severe anemia was an aggravating factor in 31.5%. Maternal deaths were associated with type 1 delay in 57.6%, type 2 delay in 9% cases, and type 3 delay in 21.2%. Conclusion: Hypertensive disorders of pregnancy and obstetric hemorrhage continue to be the leading threats to maternal lives. Improvement in public health services and special campaigns focusing on prevention of viral hepatitis and other infectious diseases can be helpful in decreasing maternal death due to indirect causes. Need of the hour is quality intrapartum and emergency obstetric care at first referral units. Indirect causes of maternal death are a significant public health issue which needs to be addressed.

Maternal Deaths after Obstetrical Referral and/or Evacuation to the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center, Togo

Introduction: Maternal death or maternal mortality is “the death of a woman occurring during pregnancy or within 42 days of termination, regardless of duration or location, for any specific cause or aggravated by pregnancy or its management, but neither accidental nor fortuitous. Methods: This was a descriptive and analytical cross-sectional study carried out from January 1st, 2021 to April 30th, 2022 at the Obstetrics Gynecology Clinic of the Sylvanus Olympio University Hospital Center (SOUHC). Results: we noted 86 cases of maternal deaths after referral/evacuation i.e. a maternal mortality rate hospital of 555 maternal deaths per 100,000 LB. The average age of the patients was 31.1 ± 6.3 years with extremes of 15 and 45 years. In 33.7% of cases our patients were resellers. Multiparas represented 33.7% of the sample, they had performed less than three antenatal consultations. Postpartum hemorrhage was the reference reason in 33.7%. In 74.4% of cases, the patients referred had arrived by taxi. In 87.9% of cases, the patients had died of direct obstetric causes. Immediate postpartum hemorrhage accounted for 44.6% of cases and anemia, 36.4%. There is a statistically significant association between the availability of blood product and the avoidability of maternal death after obstetrical referral and/or evacuation (p value = 0.0188 0.05). Conclusion: Determining responsibility for maternal death is not always easy. There is an urgent need to strengthen the policy of reducing maternal mortality in Togo. This remains possible by developing communication strategies and a solid referral/counter-referral system.

Comitê de mortalidade materna e a vigilância do óbito em Recife no aprimoramento das informações: avaliação ex-ante e ex-post

Abstract Objectives: to evaluate the contribution of the Maternal Mortality and Death Surveillance Committee for women of childbearing age (WCA) and maternal mortality in the magnitude of maternal mortality and in the qualification of the causes of death in Recife, Brazil. Methods: ex ante/ex post evaluation, ecological, of the annual indicators of mortality of WCA, maternal and case study of declared maternal deaths according to causes of death before and after surveillance. Deaths of WCA (2010 and 2017) were analyzed. The percentage of investigation of deaths of WCA was calculated; their rates and maternal mortality ratio (MMR) were estimated; the groups of causes of death, classification of death, the moment of death, the proportional variation before and after surveillance, and the relocation of the causes after this process were described. Results: 4.327 (97.0%) of deaths of WCA were investigated (increase of 40.7% of maternal deaths) and MMR of 62.9/100 thousand live births. Improved notifications of immediate/late (75.0%) and remote (300.0%) postpartum; there was a difference in direct obstetric causes, total maternal deaths and late maternal death (p&lt;0.001). Conclusion: the surveillance and the Maternal Mortality Committee showed potential in identifying the magnitude and qualification of causes of maternal death in order to propose the interventions directed to obstetric care.

IMPACT OF COVID-19 PANDEMIC ON MATERNAL MORTALITY RATIO IN A TERTIARY CARE HOSPITAL OF RAJASTHAN: A RETROSPECTIVE ANALYSIS

Objectives: Pregnancy and delivery are an important risk factor for COVID-19. The present study was carried out to see the impact of COVID 19 on maternal mortality ratio (MMR). Methods: This retrospective study was performed in the Department of Obstetrics and Gynaecology, Mahila Chikitsalya, and SMS Medical College Jaipur from January 2018 to December 2021. Data were collected from the hospital records and MMR was calculated for every year. The causes of death were also recorded and changing trends were noted. Results: In the present study, the MMR for the years 2018, 2019, 2020, and 2021 were 159.03, 112.72, 354.58, and 603, respectively, which reflects enormous increase in MMR during COVID pandemic years (2020 and 2021). Before the pandemic (2018 and 2019), maximum deaths were from direct obstetric causes (77.35%) while 22.64% maternal deaths were from indirect causes. During COVID pandemic a large percentage (53.12%) of maternal deaths were due to indirect obstetric causes, COVID pneumonitis (ARDS) being the most common cause of death. Conclusions: There was 3.59 times increase in MMR during COVID-19 pandemic in our institute. COVID pneumonitis was responsible for significant number of maternal deaths.

ENSEMBLE LEARNING BASED POSTPARTUM HEMORRHAGE DIAGNOSIS FOR 5G REMOTE HEALTH CARE

The fifth-generation (5G) communications enables various promising applications that were once impossible, e.g. remote healthcare with the help of fast and reliably delivery of medical data. Post-partum hemorrhage (PPH) refers to the massive blood loss after the birthing stage (within 24 hours), i.e.&gt;500ml for the vaginal delivery, and &gt;1000ml for the cesarean section. PPH is by far the most common cause of the mortality rate of pregnant women, as well as a primary cause of current pregnant mortality in China. Despite the great potential of prediction of PPH, there is currently no effective tool based on the limited raw data from the clinical trials. In the study, we retrospectively study the 3842 vaginal delivery cases in 2017 collected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University. In particular, we obtain the prediction based diagnostic model relying on machine learning, and we adopt the ensemble learning to accomplish this task, by combining the results of various candidate methods. According to the experimental results, the accuracy of correct PPH diagnosis would approach 96.7%; the total disseminated intravascular coagulation (DIC) prediction accuracy approaches 90.3%. In this regard, we may conclude the proposed model based on machine learning would allow us to predict successfully the risk of PPH, and assess the critical level of PPH patient. We anticipate our study results would contribute to the reduction the mortality of pregnant women. According to the 2013 World Health Statistics, the maternal mortality rate in low-income countries were 410/100,000 live births. The majority of maternal deaths occurred mainly in Asian and African countries. Major causes of maternal deaths are similar across low-income countries, often obstetric in origin including hemorrhage, hypertensive diseases and maternal infections. 94% of births in Ethiopia are estimated to occur at home and 10% of maternal deaths are attributed to PPH. Uterine atony, or lack of effective contraction of the uterus, is the most common cause of PPH followed by infection, sub involution of the placental site, and inherited coagulation deficits. The majority of these fatal obstetric complications occur during labor and immediately after birth. In the low-income countries, more than three-quarters of maternal deaths due to the direct obstetric causes occur during and after birth. Organized diagnosis and management of PPH, including administration of uterotonic agents, controlled cord traction, and uterine massage after delivery of the placenta, are required to avoid maternal death.

Individual, health facility and wider health system factors contributing to maternal deaths in Africa: A scoping review.

The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O'Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual-level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility-level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system-level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility-level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.

Estimating the Risk of Maternal Death at Admission: A Predictive Model from a 5-Year Case Reference Study in Northern Uganda.

Background Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods This was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results The average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (18.7%) and complications of abortion (2.1%), whereas malaria (23.5%) and HIV/AIDS (20.6%) were the leading indirect causes. The odds of dying were higher among women who were aged 30 years or more (OR 1.12; 95% CI, 1.04–1.19), did not attend antenatal care (OR 3.11; 95% CI, 1.36–7.09), were HIV positive (OR 3.13; 95% CI, 1.41–6.95), had a caesarean delivery (OR 2.22; 95% CI 1.13–4.37), and were referred from other facilities (OR 5.57; 95% CI 2.83–10.99). Conclusion Mortality is high among mothers referred late from other facilities who are HIV positive, aged more than 30 years, lack antenatal care attendance, and are delivered by caesarean section. This calls for prompt and better assessment of referred mothers and specific attention to antibiotic therapy before and after caesarean section, especially among HIV-positive women.

Changing Trends of Maternal Mortality in a Rural Medical College in Eastern India: A 23-Year Retrospective Study

Introduction: Maternal mortality in a region is a measure of reproductive health of women in that area. The direct causes of maternal deaths are largely preventable. A new era of more comprehensive, international development agenda-the Sustainable Development Goals (SDG 3.1) was launched by the United Nations General Assembly 2015, New York for ending preventable maternal deaths. Aim: To determine the causes and changing trends of maternal mortality in this rural centre. Materials and Methods: A retrospective observational study was carried out in the Department of Obstetrics and Gynaecology of Bankura Sammilani Medical College in West Bengal in Eastern India. Individual hospital records of all the maternal deaths, from January 1998 to December 2020 were collected. Data regarding demographic profile and reproductive parameters like gravida, parity, antenatal care and cause of death were collected. The records were divided into two four yearly periods, to compare the changing trends (1998-2001) vs (2017-2020) and three five yearly (2002-2006), (2007-2011), (2012-2016) periods. The first term (1998-2001) was taken as the reference period. Results: Comparison between first (1998-2001) and last term (2017-2020) shows significant declining trend of Maternal Mortality Ratio (MMR) (364 vs 148)/100000 live birth (p-value &lt;0.00001). Majority of deaths occurred in primigravida (57.5% vs 60.6%). Direct obstetric causes accounted for majority of the deaths, but with a declining trend (74.7% vs 66.7%). Eclampsia remained the leading direct cause (35.5% vs 32.2%) followed by haemorrhage (20.4% vs 18.8%) and sepsis (18.8% vs 15.7%) in the first term (1998-2001) vs last term (2017-2020). Jaundice 6.45% vs 10.3%, heart disease 2.15% vs 7.1%, embolism 4.3% vs 0.8%, anaemia 6.45% vs 1.6% and other diseases 5.91% vs 13.4% in the first vs last term were the indirect causes of maternal mortality. Conclusion: There is a declining trend of maternal mortality since 1998, which can be attributed to improvement at all levels of healthcare. Eclampsia/preeclampsia and its complications remain the leading cause of maternal mortality. Majority of these maternal deaths can be prevented by regular screening of highrisk cases, integrated antenatal and postnatal care, institutional deliveries, timely referral, and proper implementation of national health programmes.

Causes of Maternal Mortality in 2020 in the Kara Region (Togo)

Objective: Determine the maternal mortality rate, the epidemiological profile, the causes of death and the dysfunctions noted. Patients and method: This was a cross-sectional and descriptive study from January 1 to December 31, 2020. All maternal deaths during pregnancy or within 42 days after its termination fitting the World Health Organisation definition criteria that occurred in the seven districts of Kara region were included. The data were processed using Excel microsoft. Results: A total of 41 maternal deaths occurred among 23,456 live births, accounting for a maternal mortality ratio of 174.8 deaths per 100,000 live births. The followings were observed: the average age of 30 years; 88% married; 39% multiparous; 78% housewives without income; 5% students. Hemorrhage, preeclampsia, and complications of abortion were the main direct obstetric causes, while anemia was the main indirect obstetric cause. Factors related to deaths were inadequate quality of health care and lack of universal health insurance. The various maternal death audit reports found that 94.4% of deaths were preventable. Conclusion: Most maternal deaths would be prevented in the Kara region if women during pregnancy and the postpartum period received quality health care and the community was involved in decision-making about their health.

Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility.

Maternal mortality is considered a key health indicator of Maternal and Child Health. Considering the fact that complications are preventable and most of them are modifiable, the study has been planned to analyse maternal deaths in order to suggest recommendations for preventing it. There are various delays according to the three-delay model at primary and secondary level; therefore, interventions are needed at those levels to prevent maternal deaths. To determine the various direct and indirect causes of maternal deaths, analyse the association of medical and social factors with maternal deaths and ^to determine the predictors of maternal deaths. Hospital-based retrospective cross-sectional study of all the maternal deaths occurring in the last 4 years at a tertiary health care facility. Data were collected from the Facility Based Maternal Death Review forms. Data were entered and analysed by IBM SPSS version 25.0 software. For maternal deaths, direct obstetric causes were responsible in 128 (74.4%) and indirect causes in 45 (26.2%) cases followed by unspecified causes in 78 (45.3%) and 1 (0.6%) coincidental cause. Statistically significant associations were observed between maternal death and period of gestation, mode of delivery and outcome of delivery (P = 0.12, P = 0.04 and P < 0.001, respectively). The health professionals of primary and secondary level should be well equipped to diagnose the complications and to manage it as early as possible. Thus, maternal mortality rates can be decreased to significant level.

Impact of emerging virus pandemics on cause-specific maternal mortality time series: a population-based natural experiment using national vital statistics, Argentina 1980-2017

BackgroundEmerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. MethodsWe conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). FindingsOver this 38-year study, the MMR decreased by 58·6% (69·5 to 28·8 deaths/100,000 live births), transitioning from direct obstetric causes (67·0 to 21·1/100,000 live births; 68·4% decrease) to indirect causes (2·6 to 7·7/100,000 live births; 196·2% increase). The regression analysis showed an average reduction of -2·2%/year (95% CI: -2·9 to -1·4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4·7 and 1·6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. InterpretationThe Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications. FundingSupported by FISAR www.fisarchile.org