Factor In Maternal Mortality Research Articles

Perbandingan Pemberian Buah Naga Dan Buah Bit Terhadap Kadar Hb Ibu Hamil Di PMB RY Kecamatan Panongan Kabupaten Tangerang

Introduction: Anemia is a factor in maternal mortality. PMB RY Panongan District, Tangerang Regency, the target data for anemic pregnant women in 2020 is 13.6%; in 2021 it is 14.6% and in 2022 it is 15.8%. Prevention of anemia in pregnancy apart from Fe supplements can also be done by consuming foods that contain iron, such as dragon fruit and beets. Methods: Quasi-experimental design with pretest-posttest design with control group design. The sample is pregnant women who experience anemia in January-February 2023 as many as 30 samples using a purposive sampling technique. The intervention was given 250g once a day for 14 days. Bivariate analysis used paired sample t-test and independent t-test. Results: The results of a Univariate study of Hb levels of pregnant women before the administration of dragon fruit averaged = 10,247 gr/dl and after the administration of dragon fruit averaged = 10,627 gr/dl. Hb levels of pregnant women before the administration of beets averaged = 10,187 gr/dl and after the administration of beets averaged = 11,133 gr/dl. The results of the bivariate study obtained a p-value = 0,000. Discussion: There are differences in the effect of giving dragon fruit and beetroot on Hb levels of pregnant women. Pregnant women are expected to be diligent in consuming foods that contain iron, one of which is beetroot and lemon juice, and be obedient in consuming Fe tablets to increase Hb levels in the mother's blood.

DAMPAK PEMBERIAN KURMA SEGAR (PHOENIX DACTYLIFERA) TERHADAP KADAR HEMOGLOBIN IBU NIFAS

The maternal Death Rate is one marker to see the outcome of maternal well-being endeavors. Bleeding is a factor in maternal mortality. Anemia in pregnant women can result in bleeding during childbirth. Anemia during pregnancy and blood loss during childbirth influence iron deficiency anemia during the puerperium. The study's objective was to ascertain whether giving birth to mothers who had recently given birth increased their levels of hemoglobin (Hb). Pre-experimental research employs pretest and posttest designs for a single group. The review was conducted between June and July 2022. Purposive sampling was used to select 17 respondents for this study's sample. An observation sheet for the hemoglobin level was used in the research instrument. Analysis of data with and without bivariates According to the univariate results, up to 13 participants had generally low hemoglobin levels before the administration of date juice, i.e., 76.5%. A p-value of 0.002 was reported for bivariate results using the Wilcoxon rank sum test. This suggests that date juice for women after childbirth increases hemoglobin (Hb) levels. It is believed that in the future, after childbirth, women can eat dates to increase the level of hemoglobin (hemoglobin).

Analysis of Causes of Maternal Death in East Java Province, Indonesia

BACKGROUND: The maternal mortality rate is an indicator that reflects the mother’s health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR. AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province. METHODS: The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases. RESULTS: The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders — cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases. CONCLUSION: Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.

Gambaran Kadar Hemoglobin Pada Ibu Hamil Trimester III di Puskesmas Bandar Khalipah

Anemia is a problem that is generally experienced by pregnant women, changes in the composition of the content also affect the body's metabolism. Pregnant women tend to get anemia due to increased circulation changes to the placenta and the fetus also accumulates iron reserves. In addition, the relationship between iron and anemia is also continuous with morbidity in pregnant women. Bleeding due to anemia is the main factor in maternal mortality, which is 31.25%. The type of research used in this study is descriptive analytic. This research was conducted at Bandar Khalipah Public Health Center from May to July 2022. This examination was carried out on 10 pregnant women using the Sahli method. Based on the results of the examination, it was found that 7 people (70%) Haemoglobin increased and 3 people (30%) others did not increase. Based on the results of the examination on pregnant women who have been given Fe tablets, it can be concluded that the increase in hemoglobin levels is due to consuming iron (Fe) tablets containing iron and folic acid. Meanwhile, the hemoglobin level did not increase even though they had consumed Fe tablets because pregnant women had not received a balanced intake and diet. Pregnant women can adjust their diet, take prenatal vitamins which usually contain iron and folic acid which are good for the blood and take Fe tablets so that hemoglobin remains stable during pregnancy.

Examining the Causes of Maternal Mortality in Pregnant Women Since the Beginning of the COVID-19 Pandemic in Hamadan Province, Western Iran: A Research Article

Background: Maternal mortality prevention and delivering optimal outcomes for both mother and fetus is the utmost concern of health systems in any country. Objective: This study aimed to examine maternal mortality in pregnant women since the beginning of the COVID-19 pandemic in Hamadan province, western Iran. Examining the causes of maternal mortality can be valuable in identifying mortality factors in line with prospective strategic plans. Methods: This case series study introduces the data of seven deceased pregnant women, the deaths of whom occurred since the beginning of the COVID-19 pandemic (December 2019 – March 2021) in the hospitals of cities within Hamadan province. All data were reported at the time of death or at least 14 days after hospital admission. In this study, epidemiological features and pregnancy history, background diseases, clinical symptoms, initial vital signs, medications in use, clinical laboratory values, delivery type, and neonatal outcome were assessed, respectively. Results: In the seven maternal mortality cases reported in this study, three women succumbed to pregnancy- related causes (two cases of preeclampsia and one case of antiphospholipid syndrome), and four women to severe coronavirus disease. All deceased mothers had been admitted to the intensive care unit as a result of severe illness. Four cases concerned a background condition as well, which included thromboembolic disorders, epilepsy, and lupus. In mortality cases, two women displayed a BMI score over 30. One maternal death had occurred 42 days postpartum, while five deaths had occurred prior to 37 weeks of gestation, and one past 37 weeks of gestation. Conclusion: This report provided valuable information on maternal mortality factors. Maternal mortality necessitates a careful acquisition of monitoring data, but in the prevailing pandemic circumstances, caution necessitates raising awareness of the maternal mortality potential in women with COVID-19 diagnosis in the second or third trimester. Pregnancy care programs must focus on recognizing high-risk groups of mothers-to-be with background conditions and risk factors for pregnancy, given that early diagnosis and prompt referral are invaluable in the immediate treatment and relief of pregnant mothers-to-be.

Analysis of Causes and Contributory Factors for Maternal Mortality during Covid-19 Lockdown

Background: Covid-19 pandemic affected maternal health directly by causing respiratory disease in pregnant women as well as indirectly by affecting health care delivery and caused sharp increase in maternal mortality. Aim: This study aimed to assess causes and contributing factors for maternal mortality during six months of Covid-19 lockdown. Methodology: This was a retrospective review of all maternal mortalities over the period of six months (23rd March - 22nd September 2020) after implementation of lockdown. Information regarding demographic variables, obstetric characteristics, referral, diagnosis, cause of death and any delay present were obtained from the patient records. The data were analyzed using SPSS 11.5 and descriptive statistics was used. Results: There were 19 maternal deaths, of which one was due to accidental cause. The MMR was 419 per 100,000 live births. Mean age was 29.16 ± 9.53 years with age ranging from 16 to 49 years, 44.4% women never had antenatal check-up, mean POG at presentation was 29.7 ± 9.7 weeks. Four patients died during early pregnancy (two (11.1%) due to abortion related complications and two molar pregnancies) and six (33.3%) expired during antenatal period. Three most common causes for maternal mortality were sepsis (27.8%), hypertensive disorder (22.2%) and obstetric hemorrhage (16.7%). Covid pneumonia caused one (5.6%) mortality. Main contributory cause was anemia (50%). Major delay was in providing appropriate care timely. Conclusion: Maternal mortality was very high during lockdown and the leading cause was sepsis contributed by anemia in most cases. Delays in screening high-risk pregnancies as well as delay in appropriate treatment were responsible factors.

A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level <11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO).
 Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period.
 Material & Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019.
 Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group.
 Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study.
 Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

Estimating the Predictors of Maternal Mortality in a Southern State of Nigeria using Logistic Regression Model

The maternal mortality ratio (MMR) for Nigeria is 512 deaths per 100,000 live births, suggesting one of the highest in the world. Furthermore, disparities still exist between northern and southern Nigeria, and across the states of the country with varying contributing factors. This study therefore aimed to identify the predictors of maternal mortality in Rivers State, Southern Nigeria using the technique of logistic regression. Diagnostic study design was utilized for the study and data for women of childbearing age (15–49 years) were extracted from the Rivers State Hospital Management Board, Port Harcourt from January to December 2019. The association between the maternal mortality and selected maternal and health care related factors were tested using chi-square, and multivariate logistic regression was used to identify the effects of maternal and health care related factors on maternal mortality at 5% level of significance. The study identified maternal age, educational level, place of residence, marital status, delivery outcome, baby weight, ANC attendance and parity as the risk factors of maternal mortality in Rivers State. With the risks factors identified, policy makers will be better informed to plan intervention programmes to reduce maternal mortality in Rivers State and fast track the achievement of SDG goals on maternal health.

Obstetric Patients Characteristics Labor in Dr. M. Djamil General Hospital Padang December 2019-February 2020 Period

Introduction : Maternal death in Indonesia was still high therefore efforts was needed to suppress this maternal mortality rate.Objective : To determine risk factors of maternal mortality and morbidity.Methods : This was a descriptive study using cross sectional design with study sample including all laboring mother in Obstetric Department of Dr. M. Djamil General Hospital Padang from December 2019 to February 2020 period. Sample were collected using total sampling technique with total of 119 samples included in this study. Data was collected from patients’ medical record, including age, gestational age, gravidity, history of labor, diagnosis, method of delivery, maternal condition, and neonates condition at birth.Results : Mean of age was 30.6 ± 5.4 years, mean of maternal age was 36.1 ± 3.8 weeks, about 77 patients (64.7%) were multipara, 49 patients (41.2%) had history of spontaneous labor, most frequent diagnosis were severe preeclampsia in 20 patients (16.8%), impending eclampsia in 9 patients (7.6%), history of cesarean section 8 patients (6.7%), twin pregnancy 7 patients (5.9%), and pregnancy with positive HBsAg in 7 patients (5,9%). Total 32 patients (26.9%) were referred patients from various general hospital in West Sumatra. A total of 105 patients (88.2%) had cesarean section. Mean birth weight of neonates was 2363.4 ± 964.7 gram, mean birth length was 44.1 ± 5.9 cm, mean apgar score in the first 1 minutes was 5,9 ± 2,2, and mean apgar score in the first 5 minutes 7.4 ± 2.3. During 3 months of study, total maternal deaths were found in 3 patients due to complicated eclampsia, severe preeclampsia, and maternal congenital heart disease, while neonatal death was found in 8 babies, where 6 (75%) had IUFD, and 2 (25%) had very low birth weight dying in the first 24 hours of life due to respiratory failure.Conclusion : Most of labored mother were multiparas with history of spontaneous birth, and mostly diagnosed as severe preeclampsia with method of delivery of cesarean section, and maternal and neonatal death were still occurred.Keywords: Death, Maternal, Neonatal

Social Determinants and Ethnic Factors Associated with a New Spatial Distribution of Maternal Mortality for a City of Colombia (2000-2019)

Introduction: Maternal mortality in our region observed a significative reduction, however, it continues to be a a public health problem. In Cali-Colombia was traditionally concentrated in the eastern and hillside areas and with high prevalence of afroamerican patients.
 Materials and methods: To analyze the behavior of maternal mortality during the last twenty years in the city, an ecological analytical study of spatial correlation was carried out including in the analysis, economic, sociocultural and health care factors. Univariate, bivariate and multivariate analyzes were performed.
 Results: The spatial analysis showed clusters of maternal mortality in the northern and central areas of the city. As a risk factor for maternal mortality, it was observed that in pregnant women belonging to the mixed ethnic backgrounds and spanic white ethnicity from low socioeconomic income (IRR: 1.13, 95% CI 1.03-1.24). Access to basic education (OR: 0.66, 95% CI 0.53-0.83), attendance at prenatal care (OR: 0.95 95% CI 0.93-0.98) and access to health institutions (OR: 0.96, 95% CI: 0.95-0-97) identified as protective factors for maternal mortality.
 Conclusion: The clusters for maternal-perinatal mortality in the city during the last two decades had a significant spatial change with a new pattern of risk factors associated to maternal mortality.

PLACENTA ACCRETA IN PRIMIGRAVIDA AT PERIPHERAL SETUP – A RARE CASE REPORT

One of the risk factors for maternal mortality is morbidly adherent placenta (MAP) and accounts for 7–10% of maternal mortality cases worldwide. Placenta accreta is the most common type of MAP, while the other two types are placenta increta and placenta percreta. Placenta accrete accounts for 75–80% of MAP. Here, we present a case of 22 years old, primigravida with no known antenatal risk factors, diagnosed to have placenta accreta intraoperatively after delivering health baby. It is extremely rare for MAP to occur in a patient with no prior risk factors in a primigravida. Peripartum hysterectomy is the only option in a limited care facility with a hemodynamically unstable patient without a proper full-fledged blood bank facility. It is once again reiterated that bleeding from the vagina that does not slow or stop, drop in blood pressure and signs of shock are early signs of blood loss and should be investigated with great concern.

Bayesian multilevel model on maternal mortality in Ethiopia

Maternal mortality is one of the socio-economic problems and widely considered a serious indicator of the quality of a health. Ethiopia is considered to be one of the top six sub-Saharan countries with severe maternal mortality. The objective of this study was to investigate the effects of the Demographic and Socio-economic determinant factors of maternal mortality in Ethiopia. Data from the 2016 Ethiopia Demographic and Health Survey indicated that the sample of women (15–49) was (n = 10,103). The Bayesian multilevel we were used to explore the major risk factors and regional variations in maternal mortality in Ethiopia. Markov chain Monte Carlo methods with non-informative priors have been applied. The Deviance Information Criterion model selection criteria were used to select the appropriate model. The analysis result, 145 (1.43%) mothers were died due to pregnancy. Using model selection criteria Bayesian multilevel random coefficient was found to be appropriate. With this model, Age of mother, marital status, number of living children, wealth index and Education are found to be the significant determinants of maternal mortality in Ethiopia. The study indicated that there was within and between regional variations in maternal mortality. Inference is the fully Bayesian multilevel model based on recent Markov chain Monte Carlo techniques. The socioeconomic, demographic and environmental determinants included in the study were found to be statistically significant. The result of the Bayesian multilevel model in this study has shown that educational attainment, wealth index, an age of mother, status and number of living children was a significant factor of maternal mortality.

Contraceptive use and maternal mortality in Indonesia: a community-level ecological analysis

BackgroundPrior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood.MethodsData from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions.ResultsHigher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality.ConclusionsCommunity contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010–2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal.

Maternal mortality following thromboembolism; incidences and prophylaxis strategies

BackgroundThromboembolism is one of the main causes of maternal mortality, which can be prevented in many cases. The present study was designed to investigate the incidence and prophylaxis strategies for maternal mortality following thromboembolism in postnatal.MethodsIn this case series study, the data of the mortality cases were extracted according to the ethical and security standards of the Ministry of Health of the country and compared with a healthy control group. The thromboembolism risk factors measured and scored using a questionnaire entitled “the evaluation of risk factors for maternal mortality following thromboembolism during pregnancy, labor, or post-partum”.ResultsThe maternal mortality rate was 16 per 100,000 live births. Among 297 mortality cases, 27 (9%) death were due to thromboembolism. The mean gestational age was 32.5 weeks. Dyspnea (88.8%) and tachycardia (18.5%) were found as common clinical manifestations in these patients. Sixteen cases (59.3%) did not get heparin, 6 (22.2%) received single dose and 5 (18.5%) received two doses and more. In these 11 cases, 5 (45%) patients received heparin before surgery, 1 after surgery, and 5 before and after surgery. Twenty cases deceased in the first hours after delivery and the rest after 2 to 12 days. The average score of risk for thromboembolism based on Royal College of Obstetricians & Gynecologist (RCOG) guideline was 4.6.ConclusionIt seems that one of the most important cause of maternal mortality in this study was the lack of recognition of high-risk patients and the lack of prescription for prophylaxis with heparin and this clearly explains the need for accurate screening of high-risk mothers, designing a standard form and the care and treatment of these patients.

Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study

BackgroundMaternal mortality in sub-Saharan Africa remains high despite programmatic efforts to improve maternal health. In 2007, the Zambian Ministry of Health mandated facility-based maternal death review (MDR) programs in line with World Health Organization recommendations. We assessed the impact of an MDR program at a district-level hospital in rural Zambia.MethodsWe conducted a mixed methods convergent study using hospital data on maternal mortality and audit reports of 106 maternal deaths from 2007 to 2011. To evaluate the overall impact of MDR on maternal mortality, we compared baseline (2007) to late (2010–11) post-intervention inpatient maternal mortality indicators. MDR committee reports were coded and dominant themes were extracted in a qualitative analysis. We assessed potential risk factors for maternal mortality in a before-and-after design comparing the periods 2008–09 and 2010–11.ResultsIn-hospital maternal mortality declined from 23 per thousand live births in 2007 to 8 per thousand in 2010–11 (P < 0.01). Maternal case fatality for puerperal sepsis and uterine rupture decreased significantly from 63 and 32% in 2007 to 10 and 9% in 2010–11 (P < 0.01). No significant reduction was seen in case fatality due to postpartum hemorrhage. Qualitative analysis of risk factors for maternal mortality revealed four core themes: standards of practice, health systems, accessibility, and patient factors. Specific risk factors included delayed referral, missed diagnoses, intra-hospital delays in care, low medication inventory, and medical error. We found no statistically significant differences in the prevalence of risk factors between the before-and-after periods.ConclusionsImplementation of MDR was accompanied by a significant decrease in maternal mortality with reductions in maternal death from puerperal sepsis and uterine rupture, but not postpartum hemorrhage. Qualitative analysis of audit reports identified several modifiable risk factors within four core areas. Comparisons of potential explanatory factors did not show any differences over time. These results imply that MDR offers a means for hospitals to curtail maternal deaths, except deaths due to postpartum hemorrhage, suggesting additional interventions are needed. Documentation of MDR meetings provides an instrument to guide further quality improvements.

Risk factors assessment in patients with acute fatty liver of pregnancy treated without plasma exchange or renal replacement therapy

Objective Acute fatty liver of pregnancy(AFLP) is a rare but very urgent obstetric disease in clinical. It is a common cause of liver failure in pregnancy and often needs to be admitted to the department of critical care medicine because of the rapid development of acute hepatic dysfunction and severe acute renal dysfunction. The etiology and pathogenesis of this disorder is not very clear although there have been many studies on it before. Meanwhile, the relatively high mortality requires a better recognition in order to better guide clinical decision making. Our previous multicentre retrospective study on AFLP demonstrated that total bilirubin and serum creatinine were independent risk factors for perinatal maternal mortality. And we aim to further assess maternal outcomes and risk factors in AFLP patients treated without plasma exchange or renal replacement therapy based on previous data we collected. Methods Retrospective cohort study of 133 hospitalized patients with AFLP was collected from four Chinese tertiary hospitals during the period between January 2009 and April 2014. One hundred thirty three patients were divided into two subgroups containing patients treated without plasma exchange (PE) or renal replacement therapy (CRT) and patients treated with PE or/and CRT. Logistic regression was used to analyze independent risk factors for maternal mortality of AFLP treated without PE or CRT. Results The maternal mortality rate was 12.0% in subgroup of patients treated without PE or CRT. And in subgroup of patients treated with PE or/and CRT, the maternal mortality rate was 26.8%. Independent risk factors for maternal mortality of AFLP treated without PE or CRT were direct bilirubin (OR = 1.012; 95% CI, 1.002–1.022) and serum creatinine (OR = 1.022; 95% CI, 1.007–1.036). Conclusion Although less liver and kidney damage in AFLP treated without PE or CRT, direct bilirubin and serum creatinine remained to be independent risk factors for maternal mortality. Thus, the level of bilirubin and serum creatinine might not be necessary for AFLP to decide whether to give plasma exchange or dialysis treatment.

Study of risk factors in maternal mortality in Nehru Hospital, B.R.D Medical College, Gorakhpur

Study of risk factors in maternal mortality in Nehru Hospital, B.R.D Medical College, Gorakhpur

Maternal mortality by socio-demographic characteristics and cause of death in South Africa: 2007\u20132015

BackgroundSouth Africa’s maternal mortality ratio remains high although it has substantially declined in the past few years. Numerous studies undertaken in South Africa on maternal mortality have not paid much attention to how the causes are distributed in different socio-demographic groups. This study assesses and analyses the causes of maternal mortality according to sociodemographic factors in South Africa.MethodsThe causes of maternal deaths were assessed with respect to age, province, place of death, occupation, education and marital status. Data were obtained from the vital registration database of Statistics South Africa. About 14,892 maternal deaths of women from 9 to 55 years of age were analysed using frequency tables, cross-tabulations and logistic regression. Maternal mortality ratio (MMR), by year, age group, and province for the years 2007–2015 was calculated.ResultsThe 2007–2015 MMR was 139.3 deaths per 100,000 live births (10,687,687 total live births). The year 2009 had the highest MMR during this period. Specific province MMR for three triennia (2007–2009; 2010–2012; 2013–2015) shows that the Free State province had the highest MMR (297.9/100000 live births; 214.6/100000 live births; 159/100000 live births) throughout this period. MMR increased with age. Although the contribution of the direct causes of death (10603) was more than double the contribution of indirect causes (4289) maternal mortality showed a steady decline during this period.ConclusionsThe study shows evidence of variations in the causes of death among different socio-demographic subgroups. These variations indicate that more attention has to be given to the role played by socio-demographic factors in maternal mortality.

Efficacy, tolerability and safety of intravenous iron sucrose in postpartum anaemia

Background: Anemia is one of major contributing factor in maternal mortality and morbidity in third world countries and according to the WHO, contributes to 40% maternal deaths. Postpartum anemia is observed in up to 27% of women.It is a common problem throughout the world. Treatment of postpartum iron deficiency anemia includes oral and parenteral iron supplmentaion as well as blood transfusion in severe cases. Methods: This was a prospective longitudinal study carried out in Department of Obstetrics &amp; Gynaecology of PRH, Loni. Total 80 women suffering from postpartum anemia of age above 18 years with haemoglobin (HB) level below 11gm/dl and above 6gm/dl were included for the study. After history taking, clinical examination and baseline Hb level, all of them were administered intravenous iron sucrose 200 mg per dose per day till the total calculated dose was administered. The post therapy evaluation was done with the estimation of Hb on day 1, day 7, day 14 and day 21. Results: 31.25% women belonged to the age group each of 19-21 years and 22-24 years. Maximum number of patients received 3 doses of IV Iron sucrose (i.e. total 600mg) followed by 2 doses (i.e. total 400mg), 4 doses (i.e. total 800mg) and 5 doses (i.e. total 1000mg) respectively. Hb level rises extremely significantly (p&lt;0.001) after IV Iron Sucrose administration on day 1, 7, 14 &amp; 21 as compared to corresponding values before delivery as analyzed by Friedman Test (Nonparametric Repeated Measures ANOVA) . 16 patients (20%) experienced thrombophlebitis to IV Iron Sucrose administration. About 12 (15%) patients experienced rigor followed by sweating in 10 patients (12.5%) and fever in 8 patients (10%). About 62 patients (77.5%) from total 80 reported well tolerability to IV Iron Sucrose while remaining 18 patients (22.5%) reported poor tolerability to IV Iron Sucrose Conclusion: Intravenous iron sucrose increases the haemoglobin more rapidly in first week as compared to second and third week in women with postpartum iron deficiency anemia. Hypersensitivity reaction, chest pain, dyspnoea reported with iron dextran and iron sorbitol citric acid were not observed with iron sucrose. Intravenous iron sucrose can be used safely to fill a rift between blood transfusion and oral iron in treatment of postpartum iron deficiency anemia.

Geographical Variations in Maternal Mortality Due to Obstetric Haemorrhage and Its Association with Potential Risk Factors in Central and Western China: A Bayesian Spatiotemporal Analysis

Background: China planned to achieve its fifth Millennium Development Goals by 2015, including reducing maternal mortality. The leading cause of maternal mortality in the country is obstetric haemorrhage. However, there is limited evidence on the burden of maternal mortality due to obstetric haemorrhage. It is also unclear which ecological-level risk factor is associated with maternal mortality due to obstetric haemorrhage. Methods: The data on maternal mortality due to obstetric haemorrhage were collected from the China Maternal Mortality Surveys conducted in 1832 counties of mainland China over the 2010-2013 period. The Bayesian spatiotemporal regression and the Geodetector model were used to examine the spatiotemporal distribution of the maternal mortality ratio (MMR) due to obstetric haemorrhage, as well as its association with per capita income, the proportion of pregnant women who received antenatal care at least five times, the hospital delivery rate, and the distance from the nearest blood station (DBS). Findings: The overall MMR due to obstetric haemorrhage decreased in China, but the trends largely varied by region. There were 568 hotspot counties, located mostly in China's western regions. Western China had the highest MMR due to obstetric haemorrhage. The proportion of pregnant women who had five or more maternal checkups and the DBS were the major risk factors for maternal mortality due to obstetric haemorrhage. The MMR increased from 1.92 to 2.51 to 7.06, with an increase in the DBS from 100 km, respectively. Interpretation: The findings provide information for accurate spatial targets and public health policies to reduce maternal deaths at both country and regional levels. Funding Statement: The case study was supported by the MOST (2012CB955503), the NSFC (41271404 and 41421001), the China Medical Board (grant number 11-065), and the United Nations International Children's Emergency Fund (2016EJH011). The data were collected by Sichuan University and processed by the Institute of Geographic Sciences and Natural Resources Research. Declaration of Interests: The authors declare they have no actual or potential competing financial interests.