Risk Factor For Maternal Mortality Research Articles

Maternal and fetal/neonatal outcomes of pregnancies complicated by pulmonary hypertension: a retrospective study of 154 patients

ObjectivesTo determine the main clinical and demographic outcomes related to Pulmonary Hypertension (PH) and adverse obstetric and fetal/neonatal outcomes. MethodsThis study retrospectively analyzed the medical record data of 154 patients with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2011 and December 2020. ResultsAccording to the severity of elevated Pulmonary Artery Systolic Pressure (PASP), 82 women (53.2%) were included in the mild PH group, 34 (22.1%) were included in the moderate PH group, and 38 (24.7%) were included in the severe PH group. There were significant differences in the incidence of heart failure, premature delivery, Very-Low-Birth-Weight (VLBW) infants, and Small-for-Gestational-Age (SGA) infants among the three PH groups (p < 0.05). Five (3.2%) women died within 7-days after delivery, 7 (4.5%) fetuses died in utero, and 3 (1.9%) neonates died. The authors found that PASP was an independent risk factor for maternal mortality. After adjustment for age, gestational weeks, systolic blood pressure, Body Mass Index (BMI), mode of delivery, and anesthesia, the risk of maternal mortality in the severe PH group was 20.21 times higher than that in the mild-moderate PH group (OR = 21.21 [95% CI 1.7∼264.17]), p < 0.05. All 131 (85.1%) patients were followed up for 12 months postpartum. ConclusionsThe authors found that the risk of maternal mortality in the severe PH group was significantly higher than that in the mild-moderate group, highlighting the importance of pulmonary artery pressure screening before pregnancy, early advice on contraception, and multidisciplinary care.

Критические акушерские состояния и риск материнской смертности: данные Приволжского федерального округа

Aim: To identify additional risk factors for maternal mortality (MM) in critical obstetric conditions (COC) and opportunities for their reduction. Design: Retrospective observational sample study. Materials and methods. Analysis of 2508 cases entered into the Register of COC of the module “Obstetrics and Neonatology” of the Vertically Integrated Medical Information Systems of the Ministry of Health of Russia in the period from 01.01.2021 to 12.31.2022 in the Volga Federal District. “Patient's age”, “leading criterion of COC in the development of symptoms”, “obstetric status at the time of development of COC symptoms”, “level of obstetric care” indicators analyzed and their influence on the probability of death were studied. A total of 59 (2.7%) deaths were registered: 49 (83.1%) MM and 10 (16.9%) deaths of women during pregnancy, childbirth and the postpartum period who did not meet the criteria. 8 deaths from external causes were excluded from the analysis. After excluding patients with COVID-19, the authors identified 2201 (87.8%) cases to analyze. Results. The risk of MM increased in the presence of jaundice in preeclampsia by 70.047 times (95% confidence interval (CI): 6.206–790.68; p &lt; 0.001), ketoacidosis by 12.306 times (95% CI: 1.415–106.983; р = 0.023), cardiac arrest by 6.478 times (95% CI: 2.945–14.251; p &lt; 0.001), pulmonary edema any etiology by 4.123 times (95% CI: 1.215–13.990; р = 0.023), predicted or ongoing difficult tracheal intubation by 526.500 times (95% CI: 25.567–10842.032; p &lt; 0.001), cardiopulmonary resuscitation by 11.488 times (95 % CI: 2.170–60.824; р = 0.004), anaphylactic shock by 25.204 times (95% CI: 1.779–357.153; р = 0.017). The presence of severe preeclampsia did not significantly affect the likelihood of death (HR = 0.833; 95% CI: 0.643–1.080; p = 0.169). With the development of COC symptoms, the risk of death in a pregnant woman was 5.569 times lower than in a woman in labor, and in a postpartum woman it was 6.600 times lower. In a tertiary hospital, the probability of death was 14.226 times less. Conclusion. Certain extragenital pathology leading to the development of COC is the main risk factor for MM. Obstetric pathology is much more common, but due to the competence of obstetrician-gynecologists in secondary and tertiary obstetric hospitals, the risk of death, is significantly reduced. At the same time, at each stage of care, indications for routing the patient to a higher-level hospital should be taken into account in order to provide adequate medical care for extragenital diseases. Keywords: critical obstetric conditions, maternal mortality, mortality risks.

Maternal Mortality Risk Factors and the Role of Midwives in First Handling Maternal Emergencies based on Verbal Autopsy of the 2016-2021 Maternal Perinatal Audit Program in Bandar Lampung City

The direct cause of maternal death is more than 90% due to obstetric complications, especially complications of childbirth. Complication is a complication, aggravating circumstances of a disease. Pregnancy complications are obstetric emergencies that can cause death to the mother and fetus. Pregnancy complications include hypertension and preeclampsia, anemia, and placenta previa. Meanwhile, complications of childbirth are the occurrence of difficult labor (dystosia) which causes a disease. Labor complications include premature rupture of membranes, premature labor, abnormalities in fetal position, and others (Roberts &amp; Gammill, 2005). Knowing the risk factors for maternal death based on the main variables of delivery assistance by involving the mother's sociobiological factors, and control efforts based on verbal autopsy Maternal Perinatal Audit (AMP) in Bandar Lampung City. This study used a cross-sectional design.

Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction

BackgroundPregnant women with pulmonary hypertension (PH) have higher mortality rates and poor foetal/neonatal outcomes. Tools to assess these risk factors are not well established.MethodsPredictive and prognostic nomograms were constructed using data from a “Development” cohort of 420 pregnant patients with PH, recorded between January 2009 and December 2018. Logistic regression analysis established models to predict the probability of adverse maternal and foetal/neonatal events and overall survival by Cox analysis. An independent “Validation” cohort comprised data of 273 consecutive patients assessed from January 2019 until May 2022. Nomogram performance was evaluated internally and implemented with online software to increase the ease of use.ResultsType I respiratory failure, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide ge 1400 ng/L, arrhythmia, and eclampsia with pre-existing hypertension were independent risk factors for maternal mortality or heart failure. Type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, New York Heart Association functional class, and N-terminal pro-brain natriuretic peptide ge 1400 ng/L were independent predictors of pulmonary hypertension survival during pregnancy. For foetal/neonatal adverse clinical events, type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, parity, platelet count, fibrinogen, and left ventricular systolic diameter were important predictors. Nomogram application for the Development and Validation cohorts showed good discrimination and calibration; decision curve analysis demonstrated their clinical utility.ConclusionsThe nomogram and its online software can be used to analyse individual mortality, heart failure risk, overall survival prediction, and adverse foetal/neonatal clinical events, which may be useful to facilitate early intervention and better survival rates.

Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study

BackgroundCurrent evidence on obstetric patients requiring advanced ventilatory support and impact of delivery on ventilatory parameters is retrospective, scarce and controversial.Research QuestionWhat are the ventilatory parameters for COVID-19 obstetric patients and how does delivery impact them? And what are the risk factors for invasive mechanical ventilation (IMV) and for maternal/fetal/neonatal mortality?Study Design and MethodsProspective, multicenter, cohort study including pregnant/postpartum patients with COVID-19 requiring advanced ventilatory support in ICU.Results91 patients were admitted to 21 ICUs at 29.2±4.9 weeks-63(69%) antepartum. Maximal ventilatory support: IMV (69;76%), high flow nasal cannula (20;22%) and non-invasive mechanical ventilation (2;2%). SOFA24 was the only risk factor for IMV (OR 1.97[1.29-2.99]p0.001). Respiratory parameters at IMV onset for pregnant patients were: plateau pressure (PP) 24.3±4.5, driving pressure (DP) 12.5±3.3, static compliance (SC) 31[26-40] and PaO2/FiO2 142[110-176]. Respiratory parameters before (<2h) and after delivery (≤2h and 24h), respectively: PP (25.6±6.6, 24±6.7 and 24.6±5.2; p0.59); DP (13.6±4.2, 12.9±3.9 and 13±4.4; p0.69); SC (28[22.5-39], 30[24.5-44] and 30[24.5-44]; p0.058) and PaO2/FiO2 (134[100-230], 168[136-185] and 192[132-232.5], p0.022). Reasons for induced delivery: maternal (43/71; 60.5%), maternal and fetal (21/71; 29.5%) and fetal (7/71; 9.9%). Fourteen patients (22.2%) continued pregnancy after ICU discharge. Risk factors for maternal mortality: BMI (OR 1.10[1.006-1.204];p0.037) and comorbidities (OR 4.15[1.212- 14.20];p0.023). Risk factors for fetal/neonatal mortality: gestational age at delivery (OR 0.67[0.52-0.86]p0.002) and SOFA24 (OR 1.53[1.13-2.08]p0.006).InterpretationContrary to expectations, pregnant patient lung mechanics were similar to the general COVID-19 ICU population. Delivery was mainly induced for maternal reasons but did not change ventilatory parameters other than PaO2/FiO2. SOFA24 was the only risk factor for IMV. Maternal mortality was independently associated with BMI and comorbidities. Risk factors for fetal/neonatal mortality were SOFA24 and gestational age at delivery.

Mode of Delivery Is an Independent Risk Factor for Maternal Mortality: A Case-Control Study

(Abstracted from J Matern Fetal Neonatal Med 2022;35:1962–1968) In 2014, a systematic analysis by the World Health Organization found that the leading causes of maternal mortality were obstetric hemorrhage, hypertensive disorders, and pregnancy-related sepsis. However, in the United States, the leading causes of maternal death are cardiovascular conditions, noncardiovascular underlying medical conditions, and infection.

STUDY OF RISK FACTORS ON MATERNAL MORTALITY

Maternal mortality is still a major problem in East Flores District . Therefore, this study aimed to explain the risk factors of maternal mortality. This type of research was qualitative study with a phenomenological approach. Main informant was coordinator and village midwifes. Data triangulation was carried out on the head of the health center and the MCH manager at the district health office. Data were collected through in-depth interview and analyzed with content analysis. The results showed that the factors of maternal mortality were maternal health conditions, low K4 visits, expensive transportation costs to health facilities, more priority in handling health problems in traditional and spiritual ways and delays in referrals to health facilities. For the supervision of MCH services carried out not in accordance with the guidelines. Some of the reasons found were because midwives had not received training related to the implementation of supervision, lack of budget, decree and feedback. Conclusion: The need to improve the skills of midwives in supervising MCH for efforts to improve the quality of maternal health services.

Maternal mortality and its risk factors in Africa: A systematic review and meta-analysis

Background: Maternal mortality is a significant global health problem, which affects women of reproductive age. Maternal mortality is especially high in Africa, where more women die during pregnancy and childbirths from preventable causes. This review therefore aim to assess maternal mortality ratio and identify its risk factors. Methods: PubMed, Web of science, Embase, and Medline were searched for cohort, casecotrol and cross-sectonal studies published between 2008 and 2021that assessed maternal mortality or its risk risk in Africa, or among African women. The preferred reporting items for a systematic review and meta-analysis was carefully considered while conducting this review. Random effect model was used to generate pooled estimates. Data were analyzed using StataCorp version 16.0 statistical software. Results: A total of 1,657 articles were retrieved from searching four electronic databases. The sum of 1,639 records were excluded and a total of 18 studies were included into the the systematic review and meta-analysis. Using a random effect approach, this systematic review and meta-analysis estimated the MMR of 496/100,000 for Africa. Further, maternal age ≥ 35 years [OR = 2.50; 95% CI: (1.50, 4.15)], no formal education/illiterate mother [OR = 2.30; 95% CI: (1.50, 3.52)], no history of ANC attendance [OR = 2.42; 95% CI: (0.43, 13.50)], pregnancy complication/previous pregnancy-related illness [OR = 4.47; 95% CI: (3.03, 6.60)], delayed in seeking health care [OR = 5.12; 95% CI: (3.14, 8.34)], mother being referred [OR= 5.60; 95% CI: (4.16, 7.54)], and husband's education (illiterate/primary) [OR = 1.32; 95% CI: (0.69, 2.53)] were identified as risk factors of maternal mortality. Conclusion: A high MMR of 496/100,000 live birth for Africa was estimate in this review. Also, several risk factors of maternal mortality were identified. Healthcare professionals are therefore reminded to regularly educate mothers about the risk and benefits of seeking early prenatal healthcare

EPH49 Relationship between Pregnancy-Related Risk Factors and Receipt of Postpartum Care Among Texas Medicaid Enrollees

Compared to other developed countries, the US has the highest maternal mortality and high prevalence of pregnancy-related complications. 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). The objective of this study was to determine if there is a relationship between maternal mortality risk factors and receipt of PPC among Texas Medicaid enrollees.

Maternal mortality and its determining factors among hospitalised mothers in Tehran, Iran, 2013–2020

The maternal mortality ratio (MMR) is a significant indicator of the quality of a health care system. Despite considerable progress in reducing MMR in Iran in the past few years, we still face a long road ahead in eliminating preventable maternal deaths. In the present study, we evaluated all 80 cases of maternal deaths in 20 hospitals under the supervision of Tehran University of Medical Sciences between March 20 2013 and March 19 2020. During this time, these hospitals recorded 335,216 live births, with an MMR of 24 per 100,000 live births. The average age of deceased mothers was 31.9 ± 6.9 years. Direct causes accounted for 48.75% of maternal deaths, with haemorrhage being the most common direct cause of mortality (17.5%). Moreover, cancer (17.5%) and cardiovascular diseases (17.5%) were the most common indirect causes of maternal mortality. Even after accounting for the COVID-19 pandemic's effects, we have noticed an increase in maternal mortality. As a result, implementing a comprehensive approach for high-risk pregnancies is critical. Impact Statement What is already known on this subject? Although we have been able to reduce MMR in Iran to a reasonable level, previous measures would not be sufficient to accomplish future goals. Furthermore, we have a long way to go before reaching the ultimate goal of eradicating avoidable maternal deaths by 2030. What do the results of this study add? The causes, determinants and risk factors of maternal mortality were investigated in this study. With this level of detail, we can observe a steadily increase in MMR in recent years, regardless of the COVID-19 pandemic. The majority of pregnancy-related deaths can be avoided. What are the implications of these findings for clinical practice and/or further research? MMR reduction is a measurable goal that can be attained by improving financial resources, implementing safe delivery, team training, preparing multidisciplinary care with integration for high-risk pregnant women, establishing good provider relationships, and communicating with patients and providers for early warning signs and structural changes.

Knowledge, Attitude and Practice on Maternal Sepsis Among Mothers in Kuantan, Pahang, Malaysia

Maternal sepsis is one of the main contributors to maternal mortality worldwide. Malaysia has the least number of cases associated with maternal sepsis in 2015. However, the number of cases has increase by eight cases in 2017 as stated by the Family Health Development Division Ministry of Health Malaysia. Hence, this study aimed to investigate the knowledge, attitude and practice on maternal sepsis and its associated factors among mothers in Kuantan,Pahang. A cross sectional study design with convenience sampling were applied to 100 respondents among mothers based on specific criteria. From the findings, the majority of the mothers in Kuantan has good level of knowledge (52%), whereas the level of attitude was moderate (85%). In addition, the finding shows that the level of practice among mothers in Kuantan was excellent (76%). Maternal knowledge significantly associated with the age of the mother with p = 0.007. There was a significant correlation between knowledge and attitude (r = 0.433, p = less than 0.001) and knowledge with practice (r = 0.236, p = 0.018). While attitude and practice (r = 0.194, p = 0.053) showed no significant correlation. This study shows that the mothers in Kuantan, Pahang had good level of knowledge, moderate attitude towards maternal sepsis and excellent practice in preventing maternal sepsis. Continues education on maternal sepsis and other risk factors of maternal mortality should be done especially to young mothers in order to control and reduce the the rates of maternal mortality. Furthermore, this can be a benchmark initiative to achieve the targets in reducing maternal mortality rate in Malaysia as outlined under sustainable development goals 3 (SDG3).

Dietary iron intakes and odds of iron deficiency anaemia among pregnant women in Ifako-Ijaiye, Lagos, Nigeria: a cross-sectional study.

Introductioniron deficiency anaemia (IDA) in pregnancy is a prominent risk factor for maternal mortality and poor pregnancy outcomes in low- and middle-income countries, but studies on the significance of dietary iron intake (DII) in IDA in this population are limited. This study assessed the association of DII with odds of IDA among pregnant women attending primary health centres in Ifako-Ijaiye, Lagos, Nigeria.Methodssociodemographic information and dietary intakes were assessed among 432 singleton pregnant women (without pre-existing medical complications) using a pre-tested questionnaire and 24 hr-dietary recall, respectively. Dietary iron intake (DII) was derived from the 24 hr-dietary recall using the West African food composition table. Haemoglobin (Hb) levels in blood samples were measured using the haemoglobin-cyanide technique, and IDA was defined using the World Health Organization criteria. Multivariable-adjusted odds ratios (OR) of IDA and 95% confidence intervals (CI) by energy-adjusted tertiles of DII were estimated using logistic regression with a two-sided P<0.05.Resultsmean age of respondents was 28.5 ± 4.6 years, and the average gestational age was 31.3 ± 4.1 weeks. Mean DII was 20.3 ± 3.3 mg/day, and Hb concentration was 97.9 ± 12.9 g/L. Furthermore, 83.8% had IDA and multivariable-adjusted OR and 95% CI for odds of IDA across tertiles of energy-adjusted DII were 1.00, 0.32 (0.05, 1.77), 0.07 (0.01, 0.36) P for trend < 0.0001 adjusting for age, primigravidae status and monthly income.Conclusionhigher DII was inversely associated with the odds of IDA among pregnant women. Behavioural change communication promoting the consumption of iron-rich foods might be a viable dietary strategy to alleviate the high burden of IDA among women in this population.

Impact of a pilot workshop on student pharmacists' confidence and comfort in counseling patients at risk for maternal mortality

Background and purposeThis study examined whether a pilot workshop focused on maternal mortality had an impact on pharmacy students' confidence, comfort, and knowledge regarding preeclampsia, postpartum depression and opioid poisoning. Educational activity and settingThe two-hour workshop included lecture, video, discussion and case studies. P1-P3 student pharmacists completed pre- and post-surveys measuring confidence (N = 5) and comfort (N = 15) using a 5-point Likert type scale (1 = strongly disagree to 5 = strongly agree), as well as knowledge with 12 true/false statements. Data were analyzed using paired t-tests and McNemar's tests, as well as Cronbach's alphas for scale reliability. FindingsThe majority of participants (N = 27) were 18–25 years (85.2%), female (74.1%) and Asian (51.9%). Overall confidence and comfort increased significantly (p < .001) from pre- to post-intervention regarding: 1) preeclampsia (2.5 ± 0.9 to 4.5 ± 0.5); 2) postpartum depression (3.3 ± 0.8 to 4.5 ± 0.5); 3) opioids (3.5 ± 0.9 to 4.7 ± 0.5); 4) maternal mortality risk factors (2.1 ± 0.7 to 4.5 ± 0.5); and 5) pharmacist services related to maternal mortality prevention (2.0 ± 0.7 to 4.5 ± 0.5). Knowledge significantly (p < .05) improved on the majority (83.3%) of items. Scale reliabilities were ≥ 0.8. SummaryIncorporating maternal mortality training in colleges/schools of pharmacy curricula may have a positive impact on pharmacists' counseling and screening of patients at risk for maternal mortality in practice.

Comorbidity, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS-CoV-2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico.

ABSTRACTObjectiveMortality in pregnancy due to coronavirus disease 2019 (COVID‐19) is a current health priority in developing countries. Identification of clinical and sociodemographic risk factors related to mortality in pregnant women with COVID‐19 could guide public policy and encourage such women to accept vaccination. We aimed to evaluate the association of comorbidities and socioeconomic determinants with COVID‐19‐related mortality and severe disease in pregnant women in Mexico.MethodsThis is an ongoing nationwide prospective cohort study that includes all pregnant women with a positive reverse‐transcription quantitative polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) from the Mexican National Registry of Coronavirus. The primary outcome was maternal death due to COVID‐19. The association of comorbidities and socioeconomic characteristics with maternal death was explored using a log‐binomial regression model adjusted for possible confounders.ResultsThere were 176 (1.35%) maternal deaths due to COVID‐19 among 13 062 consecutive SARS‐CoV‐2‐positive pregnant women. Maternal age, as a continuous (adjusted relative risk (aRR), 1.08 (95% CI, 1.05–1.10)) or categorical variable, was associated with maternal death due to COVID‐19; women aged 35–39 years (aRR, 3.16 (95% CI, 2.34–4.26)) or 40 years or older (aRR, 4.07 (95% CI, 2.65–6.25)) had a higher risk for mortality, as compared with those aged < 35 years. Other clinical risk factors associated with maternal mortality were pre‐existing diabetes (aRR, 2.66 (95% CI, 1.65–4.27)), chronic hypertension (aRR, 1.75 (95% CI, 1.02–3.00)) and obesity (aRR, 2.15 (95% CI, 1.46–3.17)). Very high social vulnerability (aRR, 1.88 (95% CI, 1.26–2.80)) and high social vulnerability (aRR, 1.49 (95% CI, 1.04–2.13)) were associated with an increased risk of maternal mortality, while very low social vulnerability was associated with a reduced risk (aRR, 0.47 (95% CI, 0.30–0.73)). Being poor or extremely poor were also risk factors for maternal mortality (aRR, 1.53 (95% CI, 1.09–2.15) and aRR, 1.83 (95% CI, 1.32–2.53), respectively).ConclusionThis study, which comprises the largest prospective consecutive cohort of pregnant women with COVID‐19 to date, has confirmed that advanced maternal age, pre‐existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID‐19‐related maternal mortality. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Unsafe abortion - A Risk factor for maternal mortality in Liberia - An analysis of the characteristics of unsafe abortion clients and risk factors for maternal morbidity and mortality.

Worldwide, an estimated 68,000 women die yearly due to unsafe abortion practices. In Liberia, the maternal mortality ratio is 1072 deaths per 100,000 live births. However, there has not been a study conducted to understand the relationship between unsafe abortion and maternal mortality. We conducted a retrospective cohort study at three county hospitals and assessed obstetric data gathered using a defined questionnaire in 2016 - 2018, from maternal-child health units. The results of the study suggest a strong association between unsafe abortion and maternal morbidity and mortality and also provide insight into the characteristics and factors that put women and girls who have unsafe abortions at risk. The results can inform programs and policies on age disaggregation of women and girls who choose abortion. The variation in the association between unsafe abortion and the risk factors, have implications for maternal morbidity and mortality.

Municipality-Level Variation in Severe Maternal Morbidity and Association With Municipal Expenditures in New Jersey

Severe maternal morbidity (SMM) is a major risk factor for maternal mortality, yet little is known about geographic variation in SMM or factors associated with geographical variation at the local level. Municipal governments incur substantial expenditures providing services that are an essential part of residents' lives, but associations between municipal expenditures and SMM have not been previously examined. To investigate variation in rates of SMM across municipalities in New Jersey, the contributions of individual-level characteristics and municipal expenditures to that variation, and associations between municipal expenditures and SMM. This cross-sectional study analyzed 2008 to 2018 New Jersey birth files linked to maternal hospital discharge records and US Census municipal expenditures data. The birth files contain all birth records for New Jersey, and hospital discharge records contain information from all in-patient hospitalizations in New Jersey over the study period. Birth records were matched to maternal discharge records and expenditures data. Data were analyzed from August 2020 to August 2021. Individual-level characteristics and per capita municipal expenditures on education; public health; fire and ambulance; parks, recreation, and natural resources; housing and community development; public welfare; police; transportation; and libraries. SMM was identified using diagnosis and procedure codes developed by the Centers for Disease Control and Prevention to measure SMM. Of 1 001 410 individuals (mean [SD] age, 29.8 [5.9] years; 108 665 Asian individuals [10.9%]; 147 910 Black individuals [14.8%]; 280 697 Hispanic individuals [28.0%]; 447 442 White individuals [44.7%]) who gave birth in New Jersey hospitals from 2008 to 2018, 19 962 individuals (2.0%) had SMM. There was substantial municipality-level variation in SMM that was not fully explained by demographic characteristics. Municipal expenditures on fire and ambulance, transportation, health, housing, and libraries were negatively associated with SMM; $1000 higher annual expenditures per capita in these categories were associated with 35.4% to 67.3% lower odds of SMM (odds ratios, 0.33 [95% CI, 0.15-0.72] to 0.65 [95% CI, 0.46-0.91]). Expenditures on police were positively associated with SMM (odds ratio, 1.15 [95% CI, 1.04-1.28]). The findings in this study regarding associations between spending on various types of services at the municipal level and SMM, holding constant overall spending, population size, and socioeconomic status at the municipal level, indicate that municipal budget allocation decisions were associated with SMM rates and point to the importance of future research investigating potential causal connections.

Prevalence of Nutritional Anemia and Its Causes among Adolescent Girls

Background: Nutritional anemia is a disorder that cause due to a lack of one or more vital nutrients, such as iron, protein, vitamin B12, and other vitamins and minerals. In this condition hemoglobin content in the blood is lower than usual. Nutritional anemia has been described as correlated with reduced childhood emotional, physical, and cognitive function and is a major risk factor for maternal mortality.&#x0D; Objective: 1. To assess the prevalence of nutritional anemia among adolescent girls. 2. To assess the causes of nutritional anemia among adolescent girls. 3. To associate the demographic variable with prevalence and causes of nutritional anemia among adolescent girls.&#x0D; Methodology: This is a cross sectional observational study will be conducted among the adolescent girls where age is between 10-14 years, the sample size can be calculated statistically by using the prevalence of previous studies which done in India and the sample size is 220 adolescent girls selected in a particular rural community area of Wardha district. Non-probability convenience sampling will be using for sample collection. The standard haemoglobinometer (Accusure HB meter) for analyzing the haemoglobin according to WHO criteria and structure questionnaire scale is made upon the causes behind the nutritional anemia. According to some previous studies, the prevalence rate has been shown high in the adolescent age group so this study help to find the prevalence rate in a particular community and the causes of nutritional anemia among adolescent girls.&#x0D; Expected Results: In this study the researcher evaluate the prevalence and its causes of nutritional anemia among adolescent girls, this study will show the rate of prevalence in the particular community area and also the causes of nutritional anemia among adolescent girls.&#x0D; Conclusion: The conclusion will be drawn from the results.

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.

Risk Factors for Maternal and Fetal Mortality in Acute Fatty Liver of Pregnancy and New Predictive Models.

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening hepatic disorder that leads to considerable maternal and fetal mortality. To explore the risk factors for maternal and fetal mortality in AFLP and develop new predictive models, through this retrospective study, we analyzed the demographic characteristics, clinical symptoms, and laboratory findings of 106 patients with AFLP who were admitted to Shandong Provincial Hospital. Risk factors for maternal and fetal mortality were analyzed by univariate and multivariate logistic regression analysis. The new models based on the multivariate logistic regression analysis and the model for end-stage liver disease (MELD) were tested in AFLP. The receiver operating characteristic curve (ROC) was applied to compare the predictive efficiency, sensitivity, and specificity of the two models. Prenatal nausea (p = 0.037), prolonged prothrombin time (p = 0.003), and elevated serum creatinine (p = 0.003) were independent risk factors for maternal mortality. The ROC curve showed that the area under the curve (AUC) of the MELD was 0.948, with a sensitivity of 100% and a specificity of 83.3%. The AUC of the new model for maternal mortality was 0.926, with a sensitivity of 90% and a specificity of 94.8%. Hepatic encephalopathy (p = 0.016) and thrombocytopenia (p = 0.001) were independent risk factors for fetal mortality. Using the ROC curve, the AUC of the MELD was 0.694, yielding a sensitivity of 68.8% and a specificity of 64.4%. The AUC of the new model for fetal mortality was 0.893, yielding a sensitivity of 100% and a specificity of 73.3%. Both the new predictive model for maternal mortality and the MELD showed good predictive efficacy for maternal mortality in patients with AFLP (AUC = 0.926 and 0.948, respectively), and the new predictive model for fetal mortality was superior to the MELD in predicting fetal mortality (AUC = 0.893 and 0.694, respectively). The two new predictive models were more readily available, less expensive, and easier to implement clinically, especially in low-income countries.

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