Indirect Causes Of Maternal Death Research Articles

GAMBARAN TIPE ANEMIA PADA IBU HAMIL BERDASARKAN NILAI INDEKS ERITROSIT DI RSIA RESTU IBU TAHUN 2022

Anemia in pregnant women is a global problem that impacts both mother and fetus. Anemia in pregnancy is associated with maternal morbidity and is an indirect cause of maternal death in the entire population of pregnant women. Classification of anemia based on the erythrocyte index value is divided into normochromic normocytic, normochromic macrocytic, hypochromic microcytic and hypochromic macrocytic anemia. The erythrocyte index values ​​are divided into Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC). The aim of the research is to describe the types of anemia in pregnant women based on the erythrocyte index value at RSIA Restu Ibu Sragen in 2022. This research uses a quantitative descriptive research type with a retrospective approach. The research sample was 51 medical records of pregnant women who experienced anemia at RSIA Restu Ibu Sragen in January-December 2022 using purposive sampling. The materials and tools used were secondary data from laboratory examination results of pregnant women diagnosed with anemia which included hematocrit, hemoglobin, index erythrocytes (MCV, MCH, and MCHC), Microsoft Excel and SPSS Version 21 software. Data analysis used analysis univariate. The results of the study concluded that pregnant women who experienced anemia at RSIA Restu Ibu Sragen were aged 21-34 years with a third trimester pregnancy and were primigravida. Based on the erythrocyte index, normocytic anemia was normochromic in 18 people (35.3%), microcytic hypochromic anemia in 20 people (39.2%), and macrocytic hypochromic anemia in 13 people (25.5%). So it can be said that most pregnant women experience microcytic hypochromic anemia.

Maternal mortality review in a major tertiary referral hospital in Liberia, 2018–2021

ObjectivesAnecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020–2021). We reviewed the maternal death audit data, identified the main causes of maternal death, and associated risk factors. Findings were shared with policymakers to help reduce maternal mortality. Study designWe conducted a secondary data review and descriptive analysis of maternal death at the tertiary hospital located in Monrovia. MethodThe maternal death data were extracted from patient medical records, including death certificates and maternal audit records. The record of live births was obtained from the delivery register. Data were analyzed using Epi Info version 7.2 Maternal mortality ratio (MMR) was estimated, the leading direct and indirect causes of maternal death were identified, and the factors associated with maternal death were explored using logistic regression at a 5% level of significance. ResultsThere are a total of 233 maternal deaths and 14, 879 live births giving a maternal mortality ratio (MMR) of 1565 per 100,000 live births during the period under review. The median age of the mothers at death was 29 (14–45) years. About 40.3% (94/233) of cases died within <1 day of admission, referrals accounted for 59% (137/233) of the cases. Direct causes of death accounted for 66% (147/223). Hemorrhage [30.6% (45/147)], Eclampsia [(30/147) 20.6%] and Sepsis [(30/147) 20.6%] were the main direct causes of death while cardiovascular-related [18.4% (14/76)] and HIV/AIDS [16% (12/76)] were the leading indirect cause of death. Patients from referred other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9–10.6, p < 0.001). ConclusionThe maternal mortality ratio remained high. Referrals were done late. The Liberia Ministry of Health should equip more secondary-level health facilities and tertiary hospitals to handle maternal emergencies and sensitize the populace and healthcare workers on prompt identification and referral of obstetric emergencies. The MoH also needs to improve the blood transfusion services to help in the management of postpartum hemorrhage.

Assessment of Maternal Mortality Rate and Associated Risk Factors at Tertiary Hospitals in Burundi (2020-2021): A retrospective Cohort Study

Background: Burundi continues to struggle with maternal mortality (MM). Early risk factor identification is crucial for thorough intervention measures to be developed to prevent pregnancy-related problems. Objective: To investigate maternal mortality rate (MMR) and identify its associated risk factors among women aged 15 to 49 years at four tertiary hospitals in Burundi. Methods: We collected data describing all pregnancies from January 2020 to December 2021 among women enrolled in Centre Hospital-University of Kamenge (CHUK), Military Hospital of Kamenge (MHK), Prince Regent Charles Hospital (PRCH), and Clinical Hospital Prince Louis Rwagasore (CHPLR) referral hospitals. We reported the proportion of mothers who died per pregnancy and the MMR. Multivariate regression models were used to determine the maternal, pregnancy-related, delivery, and postpartum factors that were associated with maternal death. Results: There were 31,968 deliveries in total in CHUK, MHK, PRCH, and CHPLR referral hospitals, 125 of which resulted in maternal fatalities. The total live births were 31,067, yielding an MMR of 402/100,000 live births. Our findings suggest significant associations between MMR and direct and indirect causes of maternal death, (F (8, 116) = 2.18, p &lt; .05); haemorrhage and uterine rupture, where p was less than 0.05; community-level characteristics, (F (7, 117) = 9.91, p &lt; .05); and type of delay, (F (3, 121) = 2.76, p &lt; .05). Whereas, second delay was significantly associated with MMR, with p = 0.005. Conclusion: Reducing maternal fatalities in CHUK, MHK, PRCH, and CHPLR requires the implementation of ANC programs on the management of obstetric problems.

Hemoglobin Examination and Giving Guava Juice to Pregnant Women in Cibungbulang District, Bogor Regency

According to data from the WHO (World Health Organization), In 2017, an estimated 295,000 maternal deaths of women died during and after pregnancy and childbirth. The Ministry of Health of the Republic of Indonesia (Kemenkes RI) recorded that the number of maternal deaths in Indonesia was 4,627 people in 2020. This number increased by 8.92% from the previous year, 4,197 people. By province, 745 mothers who died were in West Java last year. The proportion reaches 16.1% of the total maternal mortality in the country. Anemia is one of the indirect causes of maternal death due to bleeding. In pregnant women, anemia increases the frequency of complications in pregnancy and childbirth. In general, one of the causes of iron deficiency anemia is insufficient iron intake and inadequate absorption (Widyastuti, 2005). Iron absorption is greatly influenced by the availability of vitamin C in the mother's body. Guava juice is a fruit easily and cheaply obtained by the public. Red guava contains carbohydrates of 12.2 g / 100 gr and fiber of 5.6 g / 100 guava fruit. So, it is hoped that pregnant women will understand their condition during pregnancy after this service. This community service was conducted through demonstrations and practices on 20 pregnant women in Cibungbulang District, Bogor Regency. This activity went well, and pregnant women felt the benefits of this service activity. Pregnant women are expected to be aware of the dangers of anemia and the benefits of detection by checking hemoglobin and consuming guava juice to increase hemoglobin levels.

An in-depth analysis of maternal mortality in a quaternary university hospital in Southern Thailand: A 16-year experience.

To perform an in-depth analysis and evaluate the causes of maternal deaths in a university hospital in Southern Thailand. A retrospective descriptive study was conducted. Medical records of all women who died during pregnancy or within 42 days of termination of pregnancy at Songklanagarind Hospital from January 2006 to December 2021 were reviewed. There were 51 910 live births during the 16-year period and 68 maternal deaths (31 of direct cause, 36 of indirect cause, and one of unknown cause). The maternal mortality ratio was 131 per 100 000 live births. There was a decreasing trend in the maternal mortality ratio, especially during the past 4 years. The leading causes of death were cardiac disease (n = 17), hypertensive disorders in pregnancy (n = 9), and postpartum hemorrhage (n = 7). The most common indirect causes of maternal death were cardiac disease, hematologic disease, and dengue hemorrhagic fever. There was a decreasing trend in indirect to direct deaths ratios during three study periods. Ratios in 2006 to 2010, 2011 to 2015, and 2016 to 2021 were 1.6, 1.4, and 0.5, respectively. The three leading causes of death were cardiac disease, hypertensive disorders in pregnancy, and postpartum hemorrhage. Improvements in the quality of obstetric care at all hospital levels are required.

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.

Mothers’ Self-Control and Self-Efficacy and Childbirth Complications: A Study at an Indonesian General Hospital

Childbirth complications are still a big problem in developing countries, especially in Indonesia and are one of the causes of high maternal mortality. This study aims to identify the relationship between self-control and self-efficacy as an indirect cause of maternal death with the incidence of childbirth complications. An analytical descriptive design with a cross sectional method was used. 175 mothers in their maternity phase were selected using the consecutive sampling technique. Self-control was measured using the Labour Agentry Scale (LAS), while self-efficacy was measured using the Childbirth Self-Efficacy Inventory (CBSEI) which had been tested for validity and reliability, and data on the incidence of childbirth complications were obtained from hospital medical records. Univariate, bivariate, and multivariate analysis with the help of computer software. The results showed that the variables of self-control and self-efficacy had a very significant relationship with the incidence of childbirth complications (p value 0.000, ?: 0.05). Mothers with poor self-control are at risk of developing complications of childbirth by 9,014 (CI 95%: 0.929 – 87,487) times greater than those with good self-control. Poor self-efficacy is at risk of developing childbirth complications 3,815 (CI 95%: 1,851 – 7,862) times greater than those with good self-efficacy. This study proves that self-control and self-efficacy are variables that influence the existence of labor complications. Antenatal care staff need to prepare mothers from pregnancy and childbirth to have the ability to control themselves and have good self-efficacy in undergoing the delivery process.

Factors influencing men’s involvement in maternal and child health: men’s experiences and religious leader’s support in Central Java, Indonesia

Background: The maternal mortality rate is still high in Indonesia and has not significantly decreased, including in Central Java. One indirect cause of maternal death is low husband involvement in improving mother and child health (MCH). This is due to cultural barriers and a lack of knowledge about the MCH problems. Therefore, this research aims to examine the significant factors influencing men’s involvement in MCH. We recommend an appropriate intervention model to engage them in MCH, primarily for their families and communities.

COVID-19 Pandemic Impact on the Maternal Mortality in Kazakhstan and Comparison with the Countries in Central Asia.

Maternal mortality ratio is one of the sensitive indicators that can characterize the performance of healthcare systems. In our study we aimed to compare the maternal mortality ratio in the Central Asia region from 2000 to 2020, determine its trends and evaluate the association between the maternal mortality ratio and Central Asia countries' total health expenditures. We also compared the maternal mortality causes before and during the pandemic in Kazakhstan. The data were derived from the public statistical collections of each Central Asian country. During the pre-pandemic period, Central Asian nations had a downward trend of maternal mortality. Maternal mortality ratio in Central Asian countries decreased by 38% from 47.3 per 100,000 live births in 2000 to 29.5 per 100,000 live births in 2020. Except for Uzbekistan, where this indicator decreased, all Central Asian countries experienced a sharp increase in maternal mortality ratio in 2020. The proportion of indirect causes of maternal deaths in Kazakhstan reached 76.3% in 2020. There is an association between the maternal mortality ratio in Central Asian countries and their total health expenditures expressed in national currency units (r max = -0.89 and min = -0.66, p < 0.01). The study revealed an issue in the health data availability and accessibility for research in the region. The findings suggest that there must be additional efforts from the local authorities to enhance the preparedness of Central Asian healthcare systems for the new public health challenges and to improve health data accessibility.

Handling obstetric emergencies: Paramedic, health informatics, and nursing interventions in prehospital care

Background: Maternal mortality rates in the UK have shown only a statistically insignificant decline, highlighting the need for urgent action. Obstetric emergencies remain a critical concern, contributing significantly to maternal mortality. The MBRRACE report underscores the challenges associated with direct and indirect causes of maternal death, particularly emphasizing conditions such as sepsis and hemorrhage. Aim: This article aims to explore paramedic and nursing interventions in managing obstetric emergencies during prehospital care, emphasizing the critical nature of timely and effective treatment. Methods: A comprehensive review of the existing literature was conducted, focusing on the management of obstetric emergencies, particularly sepsis and hemorrhage. Clinical guidelines were analyzed, highlighting key interventions and outcomes related to maternal care. Results: The findings reveal that obstetric emergencies, including sepsis and significant hemorrhage, require immediate and coordinated care from paramedics and nursing staff. Key interventions include early recognition, implementation of the sepsis-3-hour bundle, and effective communication within multidisciplinary teams. Conclusion: Enhancing the knowledge and preparedness of paramedic and nursing teams in managing obstetric emergencies is crucial in reducing maternal morbidity and mortality. Further research and continuous training are necessary to ensure that healthcare providers can respond effectively to these critical situations.

Prevalence of suicide risk and its associated factors in patients presenting in antenatal clinic

Introduction: Suicide during the antenatal period is one of the major indirect causes of maternal death. This study aims to determine the prevalence of suicidal risk and its related factors among the patients attending the antenatal clinic of a tertiary care center.&#x0D; Method: This is a cross-sectional study conducted in the antenatal clinic Patan Hospital, Lalitpur, Nepal among 124 pregnant patients using purposive sampling and face-to-face interviews applying a semi-structured proforma and P4 suicide screener. Ethical approval was obtained. The percentage of patients with suicide risk was calculated and stratified into minimal, lower, and higher risk of suicide. The association between suicide risk and different sociodemographic and clinical variables was done using the Chi-square test. A p-values ≤0.05 was considered statistically significant.&#x0D; Result: The prevalence of suicide risk was 32 out of 124 patients (25.8%). When risk stratification was done a maximum of 22(17.7%) had a higher risk for suicide. The risk was associated the employment status (p=0.039), history of previous suicide attempts (p=0.04), and diagnosed mental disorder (p=0.027).&#x0D; Conclusion: Our study shows the suicide risk among antenatal females was 25.8% reaffirming the need for proper screening and referral.

REVIEW OF MATERNAL MORTALITY AT A TERTIARY CARE HOSPITAL - A ONE YEAR STUDY

Background:Mothers are the nurturing pillar of the family. When a woman dies, the consequences have the potential to affect not only the woman herself, but her family, society and the nation as well.In 2015 globally 303,000 women died of various causes related to maternity. Aim:To determine the Maternal Mortality ratio at the tertiary care hospital for a period of one year and to identify the causes and factors leading to Maternal mortality. Material and Methods:This was a retrospective observational study carried out in the department of Obstetrics and Gynaecology at Andhra MedicalCollege and King George Hospital, Visakhapatnam, which is atertiary care centre of North Andhra.The hospital runs one ICU and Obstetric HDU, one blood bank and emergency operation theatre round the clock to provide emergencyobstetric services and critical care to their patients.The female deaths which met the WHO Criteria for Maternal Death were included in this study.The details of all the maternal deaths from January 2021 toDecember 2021 were collected from the individual case sheets and facility-based maternal death review forms. Results:During the study period January 2021 to December 2021, therewere 18,892 live births and 86 maternal deaths. The MMR in thestudy period was 455.2/100,000 live births.The maximum number of maternal deaths was seen in the age group 20-25 years, 61 cases (70.93%).The number of maternal deaths were maximum in the low socioeconomic status group with 71 cases (82.55%). Type I delay was seen in 49 cases (56.97 %). Direct causes of maternal death in the study was due to abortion in 3 cases (3.4%), hypertension in 37 cases (43.02%), obstetric hemorrhage in 22 cases (25.58%), infection/sepsis in 21 cases (24.41%) and embolism in 3 cases (3.4%) The most common indirect cause of maternal death was anemia seen in 51 cases (59.3%) Conclusion:Hypertension, hemorrhage and sepsis continue to be the leading causes of direct maternal deaths and anemia indirect cause of maternal death. Majority of deaths are preventable and with proper strategies and focusing on the 3 delays, maternal deaths can be reduced.

Hubungan Budaya dan Pengetahuan Dengan Kejadian Kekurangan Energi Kronik Pada Ibu Hamil Trimester I di Daerah Pesisir

Things that need to be considered in studying eating habits are food consumption (quantity and quality), preferences for certain foods, beliefs, taboos, or attitudes towards certain foods. Lack of knowledge of pregnant women about nutrition affects the behavior of mothers in terms of food selection in fulfilling nutrition, thus causing a lack of nutritious food during pregnancy which can cause Chronic Energy Lack (CEL) in pregnancy. The Chronic Energy Lack (CEL) caused by lack insufficient energy and protein were to pregnant women. Chronic Energy Lack (CEL) for pregnant women were arm circumference above &lt;23.5 cm and low birth weight babies (LBW) able to the potential to die, growth disorders and child development disordes. Also it was an indirect cause of maternal death. The purpose of this study was to determine the relationship between culture and knowledge with the incidence of Chronic Energy Lack (CEL) in first trimester pregnant women in coastal areas. The type of research is analytic observational with a cross sectional design to 49 respondents by purposive sampling, the subject is pregnant women who meet the inclusion and exclusion criteria by using a questionnaire. analysis using Chi-Square Test, from 49 respondents it is known that pregnant women who have good knowledge are 61.2%, pregnant women who have culture in the supportive category are 73,5% The results of the ChiSquare analysis test obtained a p value of 0.046 &lt;0.05 which means that there is a significant relationship between the relationship between knowledge and Chronic Energy Lack (CEL) in Bunder Village, Pesisir District, Pademawu District, Pamekasan Regency.

MATERNAL DEATH AND ITS CAUSES: A RETROSPECTIVE EVALUATION AT ASSAM MEDICAL COLLEGE AND HOSPITAL, DIBRUGARH, ASSAM: INDIA

Introduction: Reduction of maternal mortality ratio to achieve the target set for MMR for SDG is a global challenge. Maternal death has devastating impact on the newborn, family as well as in the society in long run. Most of the developing countries could not achieve the target MMR for MDG and are now far away from the target set for Sustainable Development Goal for maternal mortality ratio because of its gradual reduction. There are great differences in MMR in developed and developing countries as well as within the countries, states, districts depending upon the education ,socioeconomic status and provision of quality health care and its accessibility . This study was conducted to estimate the MMR , evaluate the causes of maternal deaths at Obstetrics and Gynaecology department of Assam Medical college and Hospital ,Dibrugarh Assam, India. Aim: To nd out the MMR and to evaluate the risk factors and causes of maternal deaths. Materials And Methods: A retrospective study of risk factors and causes of maternal deaths from 1st January 2019 to 31st December 2020 at Obstetrics and Gynaecology Department of Assam Medical College and Hospital Dibrugarh ,Assam ,India .The data were collected from Maternal Death Surveillance and Response Records ,Facility Based Maternal Death Review Form and Bed head tickets and analysis were made to nd out causes of death and MMR. MDSR meetings were conducted for all the maternal deaths at community , facility and CMO levels . The risk factors and causes responsible for maternal deaths were expressed in percentage Results: Results and Observations: There were 174 maternal deaths out of 22,209 live births resulting MMR of 783. Hypertensive disorders of pregnancy (37.93%) followed by Puerperal sepsis (12.64%) and Post partum haemorrhage (8.04%) were the leading direct causes and severe Anemia (10.92%) and Jaundice (5.17%) were the leading indirect causes of maternal death in our study. Conclusion:Reduction of maternal death is a global challenge to achieve the MMR target of SDG .Causes of maternal death are multifactorial .Though pregnancy and labour is a physiological condition, rapid deterioration occurs when complication arises. Targeted approach to the socioeconomically poorer section of the society is the need of the hour.

Indirect Obstetrics Causes of Maternal Death: A-20 Year Retrospective Autopsy Study at the Korle-Bu Teaching Hospital

Background: The pattern and contributions of indirect causes of maternal deaths in Ghana from autopsy data have not been studied. The aim of this study was to estimate the proportions, the spectrum and demographic characteristics of maternal deaths that resulted from indirect obstetrics causes, and to offer recommendations.Material and methods: This was a retrospective study of the above stated parameters from autopsy records in the department of pathology of Korle-Bu Teaching Hospital (KBTH).Results: Approximately 15.2%, of all maternal deaths during the period of study were indirect obstetric causes with a mean age of 28.0 years. About 32.5% of the deaths were recorded in women within 25 – 29 year age group. A little more than a third (35.9%) of the deaths occurred in a health facility. The common underlying indirect causes of death were: infections 99 (39.4%), SCD 73 (29.1%), anaemia in pregnancy 32 (12.7%), chronic liver disease (CLD) 15 (6.0%), cardiovascular disorders (CVS) 10 (4.0%), pulmonarythromboembolism (PE) 8 (3.2%) and neoplastic lesions 5 (2.0%). The common infections were: HIV/AIDS 24 (24.2%), pneumonia 19 (19.1%), purulent bacterial meningitis 17 (17.2%), malaria 9 (9.1%) and tuberculosis 8 (8.1%). The common complications of SCD leading to death were: anaemia 40 (54.8%), haemolytic crisis 10 (13.7%) and acute chest syndrome 9 (12.3%). The major complications of anaemia and CLD in pregnancy leading to death were congestive cardiac failure 28 (87.7%) and septicaemia 7 (46.7%). Deaths due to CLD 3 (37.5%) CVS 6(40.0%) and neoplastic lesions 3 (60.0%) were commoner within the age group of 30 – 34 years. Deaths due to CVS disorders 6 (60.0%) and neoplastic lesions 3 (60.0%) occurred commonly in health facilities.Conclusion: The study found that 15.2% of all maternal deaths were due to indirect causes. These commonly occurred in the community and in the 25 -29 year age group. Infections were the commonest cause of death. The authors conclude that indirect causes of maternal deaths cannot be ignored and that efforts should be focused on their reduction. Research is needed in thisarea of maternal death including the mechanisms by which these cause death and what programme could reduce it.

Relationship Between Pregnant Women's Knowledge in the Third Trimester About Childbirth and Readiness to Face Labor in Gumuruh Public Health Center

In the third trimester, pregnant women start preparing for labor to meet all the needs during pregnancy and childbirth and reduce the risk of complications during labor. Pregnant women need at least four visits during the prenatal period, and there are four aspects of preparation for childbirth: physical preparation, psychological preparation, financial preparation, and cultural preparation. Lack of maternal preparation for childbirth is one of the factors leading to high maternal mortality and infant mortality. Indirect causes of maternal death include delays in decision-making about the risks of childbirth, delays in referral, and delays in treatment. The knowledge possessed by pregnant women will determine the way she thinks about childbirth. The more knowledge the woman has about labor, the more prepared she is to face it, so she can anticipate as early as possible if there is an emergency in the labor process. The objective of this research was to identify the relationship between the level of knowledge of pregnant women in the third trimester about childbirth and the readiness to face labor in the UPT Gumuruh District of Batununggal. This study used a crosssectional approach with 40 pregnant women respondents; sampling was done using accidental sampling. Out of the 40 pregnant women examined, 36 (90%) had a high level of knowledge, and 4 (10%) had sufficient knowledge. 22 out of the 40 pregnant women (55%) had a good level of readiness, and 18 (45%) had enough readiness. The results showed a relationship between knowledge and readiness (p-value = 0.027). The level of knowledge was related to and affected the readiness of the mother to face labor. Therefore, it is essential for pregnant women, especially in the third trimester, to more actively seek information about pregnancy and labor preparations.&#x0D; Keywords: pregnant women, readiness, knowledge, childbirth

The time is now: addressing the need for training in maternal critical care medicine

Amongst many high-income countries, indirect medical conditions (e.g. cardiovascular disease, sepsis) now account for the majority of maternal deaths. In response to this concerning rise in indirect causes of maternal deaths, professional societies have developed guidelines that regionalize high-risk obstetric care and prioritize critical care expertise as a requirement for designated ‘top’ maternity hospitals. Critical care proficiency is mandated by the Accreditation Council for Graduate Medical Education for graduating obstetric anesthesiology fellows. Despite these requirements, no formal obstetric critical care educational curricula or fellowship pathways, combining critical care medicine and obstetric anesthesiology, currently exist. Dual subspecialty training in both obstetric anesthesiology and critical care medicine represents one strategy to improve the care of critically-ill obstetric patients and reduce maternal mortality and morbidity, which is one of the pressing healthcare issues of our time.

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.

PENGARUH PENDIDIKAN KESEHATAN MENGGUNAKAN MEDIA VIDEO TERHADAP KESIAPAN IBU HAMIL DALAM MENGHADAPI PERSALINAN

Problems : The indirect cause of maternal death is that there are still many late cases. Case 3 is late, including: being late in recognizing the danger signs of childbirth and making decisions, being referred too late to a health facility, being late being handled by health workers at a health service facility. Readiness in the face of childbirth is one solution to prevent maternal death. The aim of the research: to determine the effect of health education using video media on the readiness of pregnant women in facing childbirth in the working area of ​​UPTD Puskesmas Talun, Cirebon Regency. Method: The research design used a quasi-experimental design with pretest and posttest with one group design. The sampling technique was carried out by non-probability sampling technique. Sampling used a total sampling technique (30 pregnant women) in the second and third trimesters. Bivariate analysis using Wilcoxon test. Results: The results of the pre test and post test showed an increase. The effect of health education using video media on mother's readiness in facing childbirth (p value = 0.000). Conclusion: There is an effect of health education using video media on the readiness of pregnant women in facing childbirth.&#x0D; &#x0D; Keywords: Health Education Using Video Media, Readiness, Pregnant Women&#x0D;

Maternal mortality in Lebanon: Increased vulnerability among Syrian refugees.

To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018. A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of Public Health in Lebanon during the period of 2010-2018. Maternal deaths among Syrian refugees and Lebanese citizens were compared based on cause of death, age of the woman, and nationality. Causes of maternal deaths were categorized as direct and indirect following WHO definitions. The maternal mortality ratio among the Syrian refugee women in Lebanon was higher than that of Lebanese women in the period 2010-2018, with its highest rate of 55.1 in 2017. Hemorrhage and indirect causes of maternal deaths are more common among Syrian refugee women whereas embolism and hypertension have higher proportions among Lebanese women. Maternal deaths within 48h after birth are more common among Syrian than Lebanese women. Syrian refugee women carry an increased risk for maternal mortality in Lebanon. Improving timely access and equitable provision of appropriate care should be a priority for the health system in Lebanon.