Risk Factor For Maternal Mortality Research Articles

Unveiling the spectrum of cardiac disease complicating pregnancy: A comprehensive exploration of maternal and fetal outcomes

Cardiac diseases pose a significant non-obstetrical threat to maternal well-being during pregnancy, contributing to nearly 10% of maternal mortality. The intersection of pregnancy and cardiac disease presents a complex scenario, affecting approximately 1-3% of pregnancies. Rheumatic heart disease (RHD) remains a prevalent issue in developing countries, while advancements in pediatric cardiology have increased survival rates for congenital heart disease. This exploration aims to comprehensively understand the impact of cardiac diseases on maternal and fetal outcomes during pregnancy.A prospective observational study conducted over 1 year and 6 months included 40 pregnant women with cardiovascular disease. Antenatal investigations, electrocardiogram, and echocardiography were performed. Maternal and fetal outcomes were assessed, and data were presented as descriptive statistics. The study revealed a 2.07% prevalence of cardiac disease in 1926 deliveries, with a mean age of 24±4 years. Cesarean section was the predominant mode of delivery (70%). Most cases had NYHA grade I disease (80%). Maternal outcomes were uneventful in 88%, and only 12% had ICU admission. Complications due to cardiac disease were observed in 17.5% of participants. Neonatal outcomes included NICU admission (25%), low birth weight (22.5%), and preterm birth (20%).Cardiovascular complications in pregnancy affect up to 4% of cases. The prevalence in this study aligns with existing literature. Rheumatic heart disease and congenital heart disease were predominant, consistent with global trends. Maternal and perinatal outcomes were favorable in NYHA grades I and II, emphasizing the importance of early intervention and healthcare accessibility.Cardiac disease is a substantial risk factor for maternal mortality during pregnancy. The study highlights the dual risk of balancing maternal well-being and fetal development. Prevalence, complications, and outcomes underscore the significance of pre-pregnancy counseling, early detection, and multidisciplinary management for optimal pregnancy outcomes.

Risk Factors for Maternal Mortality in Banyumas Regency in 2022

Abstract Introduction: Maternal mortality Rate (MMR) in Banyumas Regency, Indonesia fluctuates. In 2022, it was the highest in Central Java Province with 24 cases spread across 14 Puskesmas. The purpose of this study was to determine the risk factors affecting maternal mortality consisting of maternal education level, anemia status, nutritional status, and history of infectious diseases.Methods: This type of research was a case control study with a sample size of 24 cases and 48 controls. The sampling method was total sampling. Education level, infectious disease, anemia, and nutritional status were investigated. This study was conducted on July to September 2023 in Banyumas Regency, Central Java, Indonesia. Data were collected through interviews using structured questionnaires. Data were analyzed with chi square tests and logistic regression.Results: The results showed that factors that increase the risk of maternal mortality were having a history of infectious diseases (OR = 5.84; 95% CI = 1.46 - 23.33, p = 0.012) and maternal Chronic Energy Deficiency (OR = 3.98; 95% CI = 1.32 - 12.01, p = 0.014).Conclusion: The risk factors for maternal mortality were infectious diseases and maternal Chronic Energy Deficiency. Early detection of risk factors such as history of infectious disease and Chronic Energy Deficiency are needed so prevention efforts can be planned. The improvement of antenatal and postnatal care through increasing the quality of health workers by providing technical and non-technical skills, especially village midwives is very important.

Knowledge of Maternal Mortality Risk Among Women with Substance Use Disorders during Pregnancy and Postpartum.

The purpose of this study was to investigate knowledge of maternal mortality risk of women with substance use disorder in the perinatal period. This study was conducted using a qualitative descriptive design. Participants were recruited from a residential substance use treatment center in a rural Midwestern city. We used semi-structured interviews during which participants described their understanding of maternal mortality risk and their related experiences. We analyzed the transcribed interviews using content analysis to yield themes and subthemes. Sixteen women participated. Three main themes were identified: Women with substance use disorder lack understanding of maternal mortality; Women with substance use disorder experience barriers to perinatal care; and Women with substance use disorder have additional risk factors for maternal mortality. Nurses can use validated screening tools, offer brief interventions, and refer women to appropriate substance use disorder treatment and mental health resources. Nurses must educate women with substance use disorder about their risk for maternal mortality as well as the signs and symptoms of perinatal mood and anxiety disorders. Nurses should provide education about the access and use of naloxone. A non-judgmental and trauma-informed approach should be used during interactions with this population.

РОЛЬ ПЕРИНАТАЛЬНОГО ЦЕНТРА МНОГОПРОФИЛЬНОЙ БОЛЬНИЦЫ В ПРОФИЛАКТИКЕ МАТЕРИНСКОЙ СМЕРТНОСТИ ОТ АКУШЕРСКИХ КРОВОТЕЧЕНИЙ: КАК БЫЛО И КАК СТАЛО

The study aims to evaluate the role of a perinatal center in a multidisciplinary hospital in the prevention of maternal mortality caused by obstetric bleeding. The study used the continuous sampling method to conduct a retrospective analysis of 185 cases of pregnancies and their outcomes in women with obstetric bleeding during pregnancy, labor, and the postpartum period treated at the Perinatal Center in Khanty-Masiysk from 2010 to 2011 and from 2019 to 2020. It was identified that primary risk factors for maternal mortality due to obstetric bleeding include iron deficiency anemia; gestational diabetes mellitus with complications; four or five pregnancies in anamnesis; and one to three scars on a uterus, which are the most significant risk factors for obstetric bleeding. From 2019 to 2020, there was a 1.3-fold increase in cases of premature detachment of normally situated placentas and a 2.5-fold increase in cases of placenta praevia with bleeding and fused placentas in the structure of hemorrhage. Taking into account existing risk factors, identifying a group of near miss cases and timely routing of patients to a level 3 medical facility is a necessary condition for preventing maternal mortality.

Maternal mortality: protocol of a study integrated to the Birth in Brazil II survey.

The Maternal Mortality Study conducts a hospital investigation of maternal deaths that occurred in 2020/2021 in the maternity hospitals sampled by the Birth in Brazil II survey, with the following objectives: estimate the maternal mortality underreporting; calculate a correction factor and the corrected (MMR); validate the causes of maternal mortality reported in the death certificate (DC); and analyze the factors associated with maternal mortality. The Birth in Brazil II includes approximately 24,250 puerperal women distributed in 465 public, private, and mixed hospitals with ≥ 100 live births/year in the five macroregions of Brazil. The Maternal Mortality Study data will be completed using the same Birth in Brazil II questionnaire, from the consultation of hospital records. Trained obstetricians will fill out a new DC (redone DC) from independent analysis of this questionnaire, comparing it to official data. The database of the investigated deaths will be related to the deaths listed in the Mortality Information System of the Brazilian Ministry of Health, allowing the estimation of underreporting and calculation of the corrected MMR. To calculate the reliability of the causes of death, the kappa test and prevalence-adjusted kappa with 95% confidence interval will be used. A case-control study to estimate the risk factors for maternal mortality will be developed with the investigated deaths (cases) and the controls obtained in the Birth in Brazil II survey, using conditional multiple logistic regression models. We expect this research to contribute to the correction of the underreporting of maternal mortality and to a better understanding of the determinants of the persistence of a high MMR in Brazil.

Mortalidade materna: protocolo de um estudo integrado à pesquisa Nascer no Brasil II

Abstract: The Maternal Mortality Study conducts a hospital investigation of maternal deaths that occurred in 2020/2021 in the maternity hospitals sampled by the Birth in Brazil II survey, with the following objectives: estimate the maternal mortality underreporting; calculate a correction factor and the corrected (MMR); validate the causes of maternal mortality reported in the death certificate (DC); and analyze the factors associated with maternal mortality. The Birth in Brazil II includes approximately 24,250 puerperal women distributed in 465 public, private, and mixed hospitals with ≥ 100 live births/year in the five macroregions of Brazil. The Maternal Mortality Study data will be completed using the same Birth in Brazil II questionnaire, from the consultation of hospital records. Trained obstetricians will fill out a new DC (redone DC) from independent analysis of this questionnaire, comparing it to official data. The database of the investigated deaths will be related to the deaths listed in the Mortality Information System of the Brazilian Ministry of Health, allowing the estimation of underreporting and calculation of the corrected MMR. To calculate the reliability of the causes of death, the kappa test and prevalence-adjusted kappa with 95% confidence interval will be used. A case-control study to estimate the risk factors for maternal mortality will be developed with the investigated deaths (cases) and the controls obtained in the Birth in Brazil II survey, using conditional multiple logistic regression models. We expect this research to contribute to the correction of the underreporting of maternal mortality and to a better understanding of the determinants of the persistence of a high MMR in Brazil.

Pregnancy-related risk factors and receipt of postpartum care among Texas Medicaid pregnant enrollees: Opportunities for pharmacist services

BackgroundThe United States (US) experiences the highest rate of maternal mortality of similar countries. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs), which are conditions in which pharmacists can have an impact. ObjectiveTo evaluate the prevalence of maternal mortality risk factors and their relationships with receipt of PPC among Texas Medicaid enrollees. MethodsA retrospective study included women with a delivery between 3/25/2014-11/1/2019 who were continuously enrolled in Texas Medicaid during the study period from 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up services. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using diagnoses and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective. ResultsThe sample (N = 617,010) was 26.5±5.7 years, primarily (52.8%) Hispanic, and 33.0% had cesarean deliveries and 9.3% had preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), and MHCs during (6.3%) and after (9.1%) pregnancy. A majority (77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR = 1.183; 95% CI = 1.161-1.206; P < 0.0001), 1.1 times higher for patients with hypertension (OR = 1.109; 95% CI= 1.089-1.130; P < 0.0001), and 1.1 times higher for patients with MHCs (OR=1.138; 95% CI = 1.108-1.170; P < 0.0001) than patients without, respectively. ConclusionOver three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and risk factors were prevalent and predictive of receipt of PPC. Pharmacists can have a positive impact on maternal health by addressing hypertension, diabetes, and MHC risk factors.

Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries.

Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.

Prevalence and risk factors of maternal mortality in Menoufia Governorate: a 5-year period prevalence study

Prevalence and risk factors of maternal mortality in Menoufia Governorate: a 5-year period prevalence study

Maternal Deaths caused by COVID-19 Infection in the First Year of the Pandemic Wave

Highlights: These cases of maternal deaths caused by COVID-19 infections illustrated the significant risk factors for maternal mortality during the early phases of the pandemic, while studies had not extensively reported this. COVID-19 infections increase the risk of maternal and neonatal mortality, with infants having a lower chance of survival even if they are delivered. Respiratory support, antiviral medications, antibiotics, anticoagulants, and supportive care are the primary treatments for severe COVID-19 in pregnancy. AbstractThis article presents seven cases of maternal deaths attributed to COVID-19 during the first year of the pandemic wave. These cases provide insights into the natural progression of COVID-19 in pregnant women who were not vaccinated. This study showed that COVID-19 significantly increased maternal and neonatal mortality and morbidity. All of the patients exhibited symptoms of fever, cough, and dyspnea upon admission to the hospital. They were admitted with elevated respiratory rates (26–32 times/minute) and low oxygen saturation (&lt;95%). Four patients had obesity, while one patient had pregestational diabetes. The COVID-19 diagnosis was established using a rapid antibody or antigen test and chest X-ray, which indicated pneumonia. Medical interventions administered to the patients included antiviral therapy (5 patients), antibiotics (6 patients), and anticoagulants (4 patients). From a total of five babies delivered, four babies were delivered via cesarean section. Two babies were not delivered due to previability and maternal deaths before delivery. The patients passed away within 3–10 days of hospital admission. In conclusion, adequate and early intervention and management of pregnant women infected with COVID-19 are crucial in preventing maternal and neonatal deaths, especially in unvaccinated women.

Systematic review and meta-analysis of maternal mortality ratio and related factors in the Islamic Republic of Iran.

Maternal mortality is an indication of the health status of women in the society. To investigate the maternal mortality ratio, causes of maternal mortality, and related risk factors among Iranian women. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Peer Review of Electronic Search Strategies (PRESS) guideline, we systematically searched electronic databases, and the grey literature, for publications in Farsi and English from 1970 to January 2022 for studies that reported the number of maternal deaths and/or maternal mortality ratio and their related factors. Data analysis was conducted using Stata 16 and 2-sided P ≤ 0.05 was considered statistically significant, if not otherwise specified. A subgroup meta-analysis of studies conducted since 2000 estimated the maternal mortality ratio as 45.03 per 100 000 births during 2000-2004, 36.05 during 2005-2009, and 23.71 after 2010. The most frequent risk factors for maternal mortality were caesarean section, poor antenatal and delivery care, unskilled birth attendance, age, low maternal education level, lower human development index, and residence in rural or remote areas. There has been a significant decrease in maternal mortality in the Islamic Republic of Iran during the last few decades. Mothers in the country need to be monitored more carefully by trained healthcare workers during the pregnancy, delivery and postpartum periods so they can effectively handle postpartum complications, such as haemorrhage and infection, thereby further reducing maternal mortality.

Timing and Preventability of Cardiovascular-Related Maternal Death.

To describe the clinical profile, management, and potential preventability of maternal cardiovascular deaths. We conducted a retrospective, descriptive study of all maternal deaths resulting from a cardiovascular disease during pregnancy or up to 1 year after the end of pregnancy in France from 2007 to 2015. Deaths were identified through the nationwide permanent enhanced maternal mortality surveillance system (ENCMM [Enquête Nationale Confidentielle sur les Morts Maternelles]). Women were classified into four groups based on the assessment of the national experts committee: those who died of a cardiac condition and those who died of a vascular condition and, within these two groups, whether the condition was known before the acute event. Maternal characteristics, clinical features and components of suboptimal care, and preventability factors, which were assessed with a standard evaluation form, were described among those four groups. During the 9-year period, 103 women died of cardiac or vascular disease, which corresponds to a maternal mortality ratio from these conditions of 1.4 per 100,000 live births (95% CI 1.1-1.7). Analyses were conducted on 93 maternal deaths resulting from cardiac (n=70) and vascular (n=23) disease with available data from confidential inquiry. More than two thirds of these deaths occurred in women with no known pre-existing cardiac or vascular condition. Among the 70 deaths resulting from a cardiac condition, 60.7% were preventable, and the main preventability factor was a lack of multidisciplinary prepregnancy and prenatal care for women with a known cardiac disease. For those with no known pre-existing cardiac condition, preventability factors were related mostly to inadequate prehospital care of the acute event, in particular an underestimation of the severity and inadequate investigation of the dyspnea. Among the 23 women who died of a vascular disease, three had previously known conditions. For women with no previously known vascular condition, 47.4% of deaths were preventable, and preventability factors were related mostly to wrong or delayed diagnosis and management of acute intense chest or abdominal pain in a pregnant woman. Most maternal deaths attributable to cardiac or vascular diseases were potentially preventable. The preventability factors varied according to the cardiac or vascular site and whether the condition was known before pregnancy. A more granular understanding of the cause and related risk factors for maternal mortality is crucial to identify relevant opportunities for improving care and training health care professionals.

Assessing Focused Antenatal Care Awareness and Utilization Among Pregnant Women in Enugu State, Nigeria: A Cross-Sectional Survey.

Focused antenatal care (FANC) is a newer and better approach to antenatal care for pregnant women than the traditional model. FANC emphasizes individual assessment and decision-making by both the provider and the pregnant woman, resulting in better health outcomes for both mother and baby. Despite the adoption of FANC care in Nigeria, maternal mortality indices have not significantly decreased. This study aimed to assess the level of awareness and utilization of FANC among pregnant women in Nigeria, as well as the factors that influence its utilization. This study was conducted in Enugu, Nigeria, using the antenatal clinics of three major tertiary hospitals. A cross-sectional design was used, and a sample size of 300 pregnant women was selected using systematic random sampling. Data were collected using a structured, self-administered questionnaire and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The findings were presented using frequencies, tables, charts, and figures, and Fisher's exact test was used to determine the relationship between respondents' knowledge of focused antenatal care and their demographic factors. A study involving 300 pregnant women in Nigeria found that only 15% of them had heard of focused antenatal care (FANC) and just 7.3% had good knowledge of its components, which was attributed to the low level of education among the respondents (X2=16.68, p=0.001). Health talks during antenatal visits were the most common source of information on FANC. The study also revealed that late initiation of antenatal care (n=144, 48%) in current pregnancy and (n=106, 54.6%) among those previously pregnant, as well as insufficient attendance, were identified as risk factors for maternal mortality. Long waiting times (n=196, 65.3%) and overcrowded healthcare facilities (n=110, 36.7%) were the major causes of dissatisfaction with antenatal care services among the respondents. Pregnant women preferred delivering at tertiary hospitals or private hospitals due to the perceived better quality of care and personal preference. These findings could inform targeted interventions to improve knowledge and awareness of FANC among pregnant women, particularly those with lower levels of education. This study provides important insights into the low awareness and utilization of FANC among pregnant women in Enugu, Nigeria, highlighting the need for targeted interventions to improve knowledge and awareness of FANC. The study's findings have important implications for the development of maternal and child health policies and interventions aimed at improving the utilization of healthcare services during pregnancy and childbirth in Nigeria. Further research that includes qualitative methods could provide more nuanced information on pregnant women's experiences and perspectives on FANC.

The assessment in patients with acute fatty liver of pregnancy (AFLP) treated with plasma exchange: a cohort study of 298 patients

BackgroundTo assess the prevalence, risk factors, clinical characteristics of Acute fatty liver of pregnancy (AFLP) patients, and outcomes of AFLP patients treated with plasma exchange (PE).MethodsWe retrospectively reviewed the AFLP patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University and Xijing Hospital of Air Force Medical University from January 2012 to May 2022. Final prediction model for death among AFLP by means of stepwise backward elimination with p value < 0.05. Patients treated with and without PE were compared by propensity-matched cohort study.ResultsTwo hundred ninety eight patients with the diagnosis of AFLP, and finally 290 patients were enrolled in the cohort study, 50 of whom (17.2%) were dead. Compared with AFLP patients alive, the dead of patients were more likely to be combined encephalopathy (p < 0.01), postpartum hemorrhage (p < 0.01), and found significantly higher frequency of fetal distress (p = 0.04), fetal death (p < 0.01). we developed a predicted probability value and with an area under the receiver operating characteristics (ROC) curve of 0.94 (95%CI 0.87 to 1.00), indicating AFLP patients’ death. The patients treated with PE had a significantly lower 60-day mortality rate (OR 0.42, 95% CI 0.29 to 2.64, p = 0.04), and significantly shorter duration of hospital-free days at day 28 (p = 0.01).ConclusionsIn conclusion, our study indicated that liver function were risk factors for maternal mortality, and PE was a protective factor for maternal 60-day mortality and hospital-free days at day 28 in AFLP patients.

Kehamilan Aman dan Nyaman dengan Pendampingan di Kelas Ibu Hamil Puskesmas Jenggot Kota Pekalongan

Pregnant Women's Class is a study group for pregnant women with gestational age between 4 weeks to 36 weeks (before delivery). Safe and comfortable pregnancy is one of the stages of life that must be prepared by a woman, in the process of pregnancy there are physiological and psychological changes due to an increase in estrogen and progesterone. Risk factors for maternal mortality during the delivery process begin with an unmonitored pregnancy. Efforts to reduce maternal mortality through maternity classes. This pregnant women class is a means to learn together about health for pregnant women, in the form of face-to-face in groups aimed at increasing the knowledge and skills of mothers regarding pregnancy, pregnancy care, childbirth, postpartum care, newborn care, myths, infectious diseases and birth certificates. The purpose of this community service is to increase the knowledge of pregnant women about pregnant women's classes. The method of providing material presented is (1) Newborn care for optimal growth and development and body mechanics, (2) safe delivery, safe postpartum, safe mother and healthy baby, (3) danger signs for pregnant women in Trimester III. Evaluation of the results of pregnant women's class activities with Post Test. The results of this activity can increase the knowledge and understanding of participants about the importance of pregnant women's classes so that they can maintain health during pregnancy and prevent / detect early if complications occur in pregnancy.

Threats Related to Maternal Mortality in Kenya: A Systematic Review

Given the high level of MMR in Kenya, this systematic review set out to systematically review studies on hazard quotients for maternal mortality in Kenya. The end goal of the review was to identify relevant empirical evidence that were included in the final study synthesis and answered the set research question and objectives. The addressed research question was ‘which are the elements of danger for maternal mortality in Kenya?’ Objectives of the study were to assess the socio-demographic risk factors for maternal mortality in Kenya and to determine the hospital based threats for maternal mortality in Kenya. Formulation of research question was guided by the population, exposure and outcomes (PEO) format. A qualitative systematic review design was adopted. The population under review was pregnant women and sample of the study included was 7. PubMed and Google Scholar were the databases used to access the included studies. CASP 2018 was used to appraise the selected/included studies. A qualitative synthesis was used by the study to present the results from the selected studies narratively. Study findings showed that individual level key risks for maternal mortality in Kenya included age, distance to healthcare centres, anaemia and labour complications. The results also showed that nurses’ attitude and mistreatment were among risk factors for ANC non-attendance and adverse health outcomes among pregnant women in Kenya. The study concludes that socio-demographic and hospital based risk factors affect MMR in Kenya and urgent steps have to be taken if SDG 3 is to be attained by the 2030 end date.

A RETROSPECTIVE STUDY ON MATERNAL MORTALITY IN A TERTIARY CARE SETUP: 2-YEAR REVIEW DURING COVID PANDEMIC

Introduction: Epidemiological data related to maternal mortality is valuable in each setup to design interventional programs to reduce the ratio favorably.This study was done to evaluate the maternal mortality rate in our hospital GGH GUNTUR from January 2020 to December 2021,to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. Objectives: 1. To estimate the maternal mortality rate in GGH Guntur 2. To identify the causes associated with maternal mortality 3. To identify epidemiological risk factors for maternal mortality 4. To recommend ideas for reducing MMR to prevent maternal deaths. Methods: This is a 2-year retrospective study conducted in our hospital, GGH Guntur, Andhra Pradesh. All data presented were collected from hospital records and the causes were assessed,some of the epidemiological risk factors were identified, and maternal mortality rates were calculated. Results: A total of 165 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years, primi women (53.33%), women from rural areas (75.15%), and unbooked patients (95.15%). Direct causes accounted for 52.27% of maternal deaths, 28.48% of maternal deaths were due to indirect causes and 17.57% of maternal deaths were due to non-obstetric causes ( 89.65 % were due to covid-19) Conclusion: Better reporting of maternal deaths and implementation of evidence-based,focused strategies,along with effective monitoring of maternal health,emphasizes the need for regulation of the private sector and encourages further public-private partnerships and policies, as well as a robust political will and enhanced management capacity for improving maternal health,particularly in an unprecedented health crisis such as Covid-19.As a considerable number of the recorded deaths are preventable,there is substantial room for advancement.

Maternal Mortality in a Rural District of Pakistan and Contributing Factors.

Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.

Risk factors of maternal and failed maternal mortality, prediction of severe obstetric conditions

Objective. To determine the priority risk factors for maternal mortality (MM) and failed maternal mortality (FMM) on the basis of clinical and epidemiological features and to develop scientifically based patient-centered models for predicting severe obstetric conditions.&#x0D; Materials and methods. Primary documentation of successful and dysfunctional maternal outcomes that occurred at the levels I, II, III of medical organizations in Perm and the territories of Perm Krai from 2007 to 2018. Using random sampling, two observation groups were formed: women with failed maternal mortality, deceased women and the control group. Analytical epidemiological "case-control" studies were carried out, which included the determination of confidence intervals, etiological accuracy using Epi Info and Excel 2016 MSO programs, a package of applied electronic tables Stat2015 of the author ( V.S. Sheludko, 20012016), the MedCalc 15.8 Portable program.&#x0D; Results. Socio-behavioral, general somatic, obstetric-gynecological risk factors, the frequency of occurrence of which among women with failed maternal mortality was 1,44,3; 1,225,5; 1,17,6 times more often, and in the group of deceased mothers 1,99,0; 1,729,5; 2,89,0 times higher than in the group of healthy participants. The "indicators of maternal death" have been identified, which increase the risk of a failed maternal death turning into maternal death. Early clinical and laboratory signs of severe obstetric conditions are the following: high leukocyte intoxication index (LII), elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine, decreased levels of fibrinogen, prothrombin index (PTI), prolongation of thrombin time (TT). Infectious-inflammatory, hypertensive complications, comorbidity, a high percentage of premature births and, accordingly, severe perinatal conditions are significantly more common in groups with unfavorable outcomes.&#x0D; Conclusions. In the course of the study, reliably significant risk factors were identified, on the basis of which scientifically based models for assessing the probability of developing critical obstetric conditions were worked out.

Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study

Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study