Predictors Of Maternal Mortality Research Articles

Liver transaminase enzyme analysis as a predictor of poor maternal outcome in pregnant women with dengue

To find out predictive value of elevated liver transaminases as a predictor of poor maternal outcome in pregnant women with dengue infection.Our study was a retrospective study, conducted in a tertiary care centre of North India from July 1 to December 31, 2021. Data of all the pregnant women with dengue infection during the above period was screened for maternal and fetal outcomes. Elevated liver transaminases in women who developed DHF, DSS and maternal mortality were the main outcome measures. Mode of delivery, obstetric complications, medical complications (Dengue Hemorrhagic Fever, Dengue shock syndrome and Acute Respiratory Distress Syndrome) and KFT for prediction of maternal mortality were the secondary outcome measures.The association of liver transaminases derangement with stage of dengue at diagnosis were analysed using Fisher’s exact test. Data analysis was done with Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, version 21. P value of less than 0.05 was considered statistically significant. A total of 35 women were included in the study. The mean age was 23.49 + 2.94 years. Acute respiratory distress syndrome, acute kidney injury, atonic PPH, and puerperal sepsis developed in 6(17.14%), 7(20%), 4(8.57%), and 10 (28.57%) women respectively. The maternal mortality rate was 25.71%. All women who developed DHF (3 women) and DSS (9 women) had altered liver enzymes. Alanine transaminase has very high sensitivity (100%) and specificity (76.92%) as a predictor of maternal mortality in pregnant women with dengue, (p<0.05). Similarly, serum creatinine levels at a value of more than 0.9 mg/dl had a sensitivity and specificity of 88.89% and 92.31%, respectively for predicting maternal mortality in pregnant women with dengue, (p<0.05). Conclusion: Elevated liver transaminases can be used as predictors of poor maternal outcome in pregnant women with dengue infection.

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.

Clinicobiochemical Parameters and Predictors of Liver Disease in Hospitalized Asian Indian Pregnant Women in a Tertiary Care Center in Northern India

Introduction During pregnancy, liver dysfunction is more frequent than expected and may require specialized care. For the early diagnosis, it is important to determine if changes in liver physiology may develop into liver disease. Liver disease during pregnancy may require intervention from a hepatologist for adequate monitoring of mother-fetus health outcomes. This study was aimed to evaluate the clinical profile and predictors of maternal mortality in patients with liver diseases among Asian-Indian-females.MethodsWe conducted a prospective, open-label, consecutive all-comers study of 2,663 pregnant Asian Indian women admitted in the hospital, which included 92 with liver dysfunction. The medical aspects of the pregnancy were then followed prospectively with laboratory and clinical data during the hospital stay and analyzed. The current study was approved by the Institutional Ethical Committee.ResultsWe found that 92 out of 2,663 patients had liver dysfunction with a prevalence of 3.45%. Fifty-four (58.7%) patients had icterus followed by fever in 23 (25.0%), hypertension in 22 (23.9%), central nervous system manifestations in 21 (22.8%), abdominal pain in 19 (20.6%), vomiting in 19 (20.6%), and pruritus in six (6.5%). Predictors of maternal mortality were icterus (p = 0.04), hepatomegaly (p = 0.04), presenting serum-bilirubin greater than 10 milligram% (mg%) (p = 0.008). The most common etiology was acute viral hepatitis (45.6%), followed by a hypertensive disorder of pregnancy (29.3%), acute fatty liver of pregnancy (1.1%), cholestatic jaundice (9.8%), hyperemesis gravidarum (2.2%), septicemic hepatitis (3.3%), dengue immunoglobulin M (IgM), and plasmodium vivax malaria antigen positive in (2.2%) each. Four patients (4.3%) were leptospira IgM reactive and had co-infection with hepatitis E virus. There was one patient (1.1%) with underlying chronic liver disease. Idiopathic liver disease was present in 5.4% of patients.ConclusionLiver disease is relatively common in Indian pregnant women. It is associated with high maternal and perinatal mortality, even in a tertiary referral center. When managing pregnancy in a tertiary care center, for adequate follow-up of the disease and to prevent adverse consequences for mother and child, it is important to discard liver alterations early. For this purpose, liver disease during pregnancy needs early diagnosis for proper management. Furthermore, it is difficult to manage patients with preexisting liver disease, and it may require specialized intervention from a hepatologist and a gastroenterologist.

Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care.

Introduction Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital. Methods A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value less than 0.05 was considered indicative of statistically significant. Results A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively. Conclusion Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients.

The use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: A prospective study from Western India.

The aim of this study is to study the etiology, clinical profile, and prognostic factors related to maternal and fetal health in pregnant patients with liver disease in Western India. This study included 103 consecutive pregnant patients with liver dysfunction from August 2013 to July 2015, who underwent regular biochemical tests, viral markers, ultrasound of abdomen, etc. and were followed up for 6weeks postpartum or until death. Pregnancy-specific causes of liver dysfunction were found in 39% (40/103) patients. Liver diseases were most frequent in third trimester 69.9% (72/103). Etiologies in third trimester were viral hepatitis 36.1% (26/72), pregnancy induced hypertension (PIH) 30.5% (22/72), intrahepatic cholestasis of pregnancy 11.1% (8/72), acute fatty liver of pregnancy (2/72), etc. Hepatitis E was the commonest agent among viral hepatitis 71.8% (28/39). Causes of maternal mortality (n = 25) were hepatitis E 40% (10/25), PIH 32% (8/25), and tropical diseases 20% (5/25). Fetal mortality (n = 31) was 38.7% (12/31) in hepatitis E. Maternal mortality was significantly associated with presence of jaundice, fever, abdominal pain, oliguria, anemia, leukocytosis, and coagulopathy. Model for end-stage liver disease (MELD) score >21 predicted maternal mortality with 80% sensitivity and 91% specificity (area under the receiver operating characteristic curve = 0.878 and p < 0.001). Liver disease was most common in the third trimester of pregnancy. Hepatitis E was the most common cause of liver disease in pregnant women in western India with significant maternal mortality, predicted by high MELD score.

The Association Between Government Health Care Spending and Maternal Mortality in the European Union, 1981 to 2010: A Retrospective Study

(BJOG. 2015;122(9):1216–1224) Government health care expenditure per capita, on a national level, is a predictor of maternal mortality, which the authors of this study defined as death of a woman during pregnancy, childbirth, or within 42 days of delivery from obstetric causes. In turn, maternal mortality is commonly used as a marker for the performance of a country’s health care system. In the present study, authors determined associations between decreases in government health care spending and maternal mortality over a 30-year period (1981 to 2010) in 24 European Union countries, with the goal of elucidating the impact of government health care spending on survival in the parturient population.

Maternal Mortality in Ghana: Impact of the Fee-Free Delivery Policy and the National Health Insurance Scheme

&lt;p&gt;Maternal mortality (MMR) is the second largest cause of female deaths in Ghana. Yet, many households cannot afford the cost of skilled delivery The study utilized the Panel Data Model to examine the impact of the fee-free delivery (FDP) and the National Health Insurance Policy (NIP) exemptions on MMR in Ghana. The Demographic and Health Survey reports on Ghana from 2002 to 2009 served as the main data source. Data were analyzed using Panel data model with within group fixed effects estimator. MMR declined significantly over the period studied. Both FDP and NIP positively impacted MMR at a 5% level of significance. In addition, skilled delivery was a significant predictor of MMR. Stakeholders would do well to ensure NIP is adequately funded in order to sustain the decline in MMR.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;br /&gt;&lt;/strong&gt;&lt;/p&gt;

A clinical characteristic analysis of pregnancy-associated intracranial haemorrhage in China.

Intracerebral haemorrhage (ICH) occurring during pregnancy and the puerperium is an infrequent but severe complication with a high mortality and poor prognosis. Until recently, previous studies have mainly focused on the effect of different treatments on prognosis. However, few studies have provided solid evidence to clarify the key predisposing factors affecting the prognosis of ICH. In the present study, based on a unique sample with a high ICH incidence and mortality rate, we described the main clinical characteristics of ICH patients and found that the prognosis of patients who underwent surgical intervention was not better than that of patients who received other treatment modalities. However, pre-eclampsia patients had higher maternal and neonatal mortality rates than other aetiology groups. Furthermore, univariate regression analysis identified onset to diagnosis time (O-D time) and pre-eclampsia as the only factors showing independent correlation with poor maternal outcomes (modified Rankin Scale, mRS ≥ 3), and only O-D time was identified as a predictor of maternal mortality. These results revealed that the aetiology of ICH and O-D time might be crucial predisposing factors to prognosis, especially for patients with pre-eclampsia. The study highlighted a novel direction to effectively improve the prognosis of pregnancy-associated ICH.

Maternal mortality predictors in women with hypertensive disorders of pregnancy: a retrospective cohort study.

Hypertensive disorders of pregnancy (HDP) are multisystem disorders unique to human pregnancy. They are becoming the leading causes of maternal mortality worldwide, with the majority of deaths occurring in low income countries. However, little is known about the predictors of maternal mortality in women with HDP. A retrospective cohort study was conducted between 2008 and 2013 in three university teaching hospitals among 1015 women admitted with a diagnosis of HDP. Statistically significant associations were assessed by the hazard ratio (HR) with 95% confidence using the Cox proportional hazards model and by the Log Rank test using the Kaplan-Meier survival analyses. There were 51(5%) maternal deaths and the majority died after they developed eclampsia. The median delay in arrival among the deaths was longer than the survivors. The multivariate survival analyses showed an increased risk of maternal mortality among women with eclampsia (HR=8.4), no antenatal care (HR=2.3), being grand multiparous (HR=2.8), having low diastolic blood pressure (HR=4.5), high creatinine level (HR=9.9), use of diazepam as anticonvulsant (HR=2.7) and untreated with antihypertensive drug (HR=4.2). The case fatality rate of HDP was among the highest in the world and a delay in initiation of treatment because of delay in health care-seeking contributed to the majority of maternal deaths.

Predictors of maternal mortality and near-miss maternal morbidity

To identify risk factors for life-threatening maternal outcomes. Hospital charts were reviewed for cases of maternal mortality or near-miss and for controls overmatched 1:3. Significant risk factors were identified through simple and best subsets multiple logistic regression. Eight cases of mortality and 69 near-miss cases were found. Significant risk factors with their odds ratios and 95% confidence intervals are: age 35 to 39 years (2.3, 1.2 to 4.4) and >39 years (5.1, 1.8 to 14.4); African-American race (7.4, 2.5 to 22.0) and Hispanic ethnicity (4.2, 1.3 to 13.2); chronic medical condition (2.7, 1.5 to 4.8); obesity (3.0, 1.7 to 5.3); prior cesarean (5.2, 2.8 to 9.8) and gravidity (1.2, 1.1 to 1.5 per pregnancy). In multivariable logistic regression, race remained significant while controlling for other significant factors and markers of socioeconomic status. Some risk factors can be modified through medical care, education or social support systems. Racial disparity in outcome is confirmed and is unexplained by traditional risk factors.

Characteristics of preeclampsia- and eclampsia-related maternal death in rural Haiti

Objective. The maternal mortality ratio in Haiti remains one of the highest in the world at 600/100 000 live births. Preeclampsia- and eclampsia-related complications are one of the leading causes of maternal death. In this resource-limited setting, effective, efficient hospital-based interventions are necessary to reduce this risk. Our objective was to assess the utility of common laboratory and clinical admission data for the determination of preeclampsia- and eclampsia-related maternal death.Study design. We performed an analysis of women presenting to the Hôpital Albert Schweitzer with preeclampsia and eclampsia during a 3-year period. Factors analyzed were: maternal age, parity, gestational age, hematocrit, serum creatinine, urine protein, systolic and diastolic blood pressure, intrauterine fetal death (IUFD), coma on arrival, and address (residence within or outside hospital catchment area). Stepwise logistic regression identified factors predictive of maternal mortality.Results. Preeclampsia/eclampsia affected 423 of 2295 deliveries (18%) and resulted in 19 deaths. Multivariate analysis identified the following predictors of maternal mortality: IUFD (RR 7.57; 95% CI 2.76–12.69), eclampsia (RR 6.91; 95% CI 2.08–12.64), and oliguria (RR 5.39; 95% CI 1.80–10.69).Conclusion. In this setting, traditional admission laboratory and clinical tests were not useful in maternal mortality prediction. The analysis highlights clinical characteristics of women at highest risk for maternal death.

Factors associated with maternal mortality in Addis Ababa, Ethiopia.

A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.