Risk Factors For Maternal Death Research Articles

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 & 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.

Kelas Ibu Hamil untuk Meningkatkan Kesejahteraan Ibu dan Janin di Posyandu

Pregnant Women Class is a study group for pregnant women with a gestational age of between 4 weeks and 36 weeks (before delivery). Pregnancy is one of the stages of life that must be prepared by a woman, in the process of pregnancy physiological and psychological changes occur due to an increase in estrogen and progesterone. The risk factors for maternal death during childbirth began from under-monitored pregnancy. One of the efforts to reduce maternal mortality is through classes for pregnant women. This class for pregnant women is a means to learn together about health for pregnant women, in the form of face-to-face in groups that aims to increase the knowledge and skills of mothers regarding pregnancy, pregnancy care, childbirth, postpartum care, newborn care, myths, diseases. infection and birth certificates. The objectives of implementing this community service are: Increasing interaction and sharing experiences between participants (pregnant women and pregnant women) and between pregnant women and health workers/midwives, Increasing understanding, attitudes and behavior of pregnant women about classes for pregnant women, body changes and complaints, treatment pregnancy and preparation for delivery. To be able to improve the knowledge and skills of mothers regarding pregnancy, pregnancy care, childbirth, community service can be carried out in the form of maternal and child health counseling that can be carried out through pregnant women classes. From the results of the activity, it can be concluded that the activity went smoothly, the participants were enthusiastic in participating in the counseling and question and answer session and were active in doing pregnancy exercise, most of the participants said they felt relaxed and excited after participating in the pregnancy exercise and were also ready to wait for the delivery process.

Clinical characteristics and risk factors for maternal deaths due to COVID-19 in Brazil: a nationwide population-based cohort study.

BackgroundMonitoring the characteristics and associated factors for death among pregnant and postpartum women with COVID-19 is necessary. We investigated the clinical characteristics and risk factors associated with maternal deaths in a nationwide cohort of Brazil.MethodsThis was a population-based cohort of all pregnant and postpartum women hospitalised with COVID-19 notified to the Sistema de Informação de Vigilância Epidemiológica da Gripe of Brazil (SIVEP-Gripe), from February 2020 to September 2021. The primary outcome was time to in-hospital death, with risks factors analysed with univariable and multivariable Cox proportional hazards regression models.ResultsCumulative observation time was 248 821 person-days from hospital admission to the end of follow-up for 15 105 individuals. There were 1858 deaths (12.3%) for a maternal mortality rate of 7.5 (95% CI 7.1–7.8) per 1000 patients-days. The cumulative mortality increased over time. Black/Brown ethnicity had a higher risk of death than women self-identifying as White. Women in the North, Northeast, Central-West and Southeast regions had higher risk of death than women in the South region. The characteristics independently associated with death were a postpartum status on admission (adjusted HR 1.4 [95%CI 1.2–1.6]), pre-existing clinical conditions (adjusted HRs 1.2 [95%CI 1.1–1.3] for one and 1.3 [95%CI 1.1–1.5] for two comorbidities), hypoxemia on admission (adjusted HR 1.2 [95%CI 1.1–1.4]) and requiring non-invasive (adjusted HR 2.6 [95%CI 2.1–3.3]) or invasive ventilatory support (adjusted HR 7.1 [95%CI 5.6–9.2]).ConclusionIn Brazil, the in-hospital maternal mortality rate due to COVID-19 is high and the risk of death increases with the length of hospitalisation. Socio-demographic and biological factors are associated with an increased risk of maternal death. The presence of respiratory signs and symptoms should be considered as an early markers of disease severity and an adequate management is necessary. Our findings reinforce the need for vaccination of pregnant and postpartum women against COVID-19.

Pregnancies in women with moderate and severe pulmonary hypertension remain challenging: A single-center experience in East China.

To determine the outcomes in women with pulmonary hypertension (PH) and determine the factors related to adverse outcomes. Data from 684 women with PH admitted to the Affiliated Renji Hospital from January 2001 to December 2020 were collected. Outcomes were compared based on the causes and severity of PH. The overall mortality was 2.8%, decreasing from 6.6% in 2001-2005 to 1.7% in 2016-2020 (P=0.10). Idiopathic PH had the highest mortality (35.3%) and the lowest live birth rate (82.4%). Mortality was similar between moderate and severe PH (5.3% versus 9.7%), but the live birth rate was much lower in severe PH (78.6% versus 89.9%). Hypoxemia and vaginal birth were risk factors of maternal death (odds ratio [OR] 35.28, 95% confidence interval [CI] 1.42-878.75; OR 850.86, 95% CI 5.67-127606.74, respectively). General anesthesia was a risk factor in the univariate analysis (OR 12.07, 95% CI 3.72-39.15) but was not significant in the multivariate analysis (P=0.16). The mortality rate in this retrospective study was lower than that previously reported. Pregnancy is safe in mild PH but still has a high risk of complications in moderate and severe PH. Hypoxemia is a risk factor for maternal death, but cesarean section may be a protective factor.

Risk factors of maternal death in preeclampsia

Aim. To determine the factors contributing to maternal death due to preeclampsia.Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

Non Tubal Ectopic Pregnancy

Non-tubal ectopic pregnancies are risk factors for maternal death and require prompt diagnosis and treatment. However, there are no established guidelines for their treatment because their rarity and care is individualized. We retrospectively reviewed the medical records of non-tubal ectopic pregnancies at our institution between May 2009 and September 2020. Thirty-four relevant cases were identified, including 14 interstitial, seven cervical, six peritoneal, three caesarean scars, two ovarian, and two rudimentary horn pregnancies; 23 of the 34 cases were diagnosed before treatment using ultrasound or magnetic resonance imaging. All patients were examined before nine weeks of gestation, and 17 were examined for a positive pregnancy test without any symptoms. In conclusion, in our hospital, non-tubal ectopic pregnancies were identified early, resulting in successful treatment without serious complications.

Predictors of contraceptive method mix in the Cameroon development corporation plantation camps.

Introductionlow socioeconomic status is a risk factor for maternal death and contraceptive use has been shown to reduce maternal deaths in those poor settings. Despite the tremendous benefits of contraceptives in the regulation of reproductive health indicators, its use in less developed countries continue to remain unacceptably low. The purpose of this study was primarily to assess the contraceptive method mix and then determine the predictors of contraceptive use in the Cameroon Development Corporation (CDC) plantation camps.Methodsmix sampling was used. Firstly, two CDC camp localities (Tiko and Pena Mboko) were purposively selected. Pre-existing clusters within these localities were then randomly selected and then eligible participants within the sampled clusters systematically selected. Using the main street junction as starting point, direction of sample collection was determined by spinning a plastic bottle. From the start of street junction and moving in direction of the bottle pointer, all households left to the principal investigator were visited in search of eligible participants which were sexually active women aged 15-49 years who gave consent/assent. One participant was selected per household. We used pretested interviewer-administered questionnaires that covered information on socio-demographic characteristics, reproductive health and contraceptive use. Statistical significance was set at p-value ≤ 0.05.Resultssix hundred and thirty four (634) sexually active women aged 15-49 years were included in the study; majority were 25-35 years (246; 38.8%). The current contraceptive prevalence was 63.1% [59.3-66.8] (400); of which 312 participants (78%) used a single method while 88 (22%) participants used contraceptives in combination. The most common methods in use were rhythm (196; 49%), male condom (109; 27.2%) and implants (63; 15.8%). When adjusted, statistically significant determinants for contraceptive use were age range and marital status such that odds of using contraceptives was lower in women < 35 years and those cohabiting (AOR= 0.71 [0.50-1.00] and AOR=0.62 [0.44-0.87] respectively).Conclusioncurrent contraceptive practice in the CDC plantation camps is geared toward less effective traditional methods than the more effective modern methods. More health education is needed to adjust this paradigm.

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.

ObjectiveTo describe clinical characteristics of pregnant and postpartum women with severe COVID‐19 in Brazil and to examine risk factors for mortality.DesignCross‐sectional study based on secondary surveillance database analysis.SettingNationwide Brazil.Population or sample978 Brazilian pregnant and postpartum women notified as COVID‐19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020.MethodsData was abstracted from the Brazilian ARDS Surveillance System (ARDS‐SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression.Main outcome measuresCase fatality rate.ResultsWe identified 124 maternal deaths, corresponding to a case fatality rate among COVID‐19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID‐19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect.ConclusionsNegative outcomes of COVID‐19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period.Tweetable abstractA total of 124 COVID‐19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.

Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data.

ObjectiveTo examine the risk factors for pregnancy-related death in India’s nine Empowered Action Group (EAG) states.DesignSecondary data analysis of the Indian Annual Health Survey (2010–2013).SettingNine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.Participants1 989 396 pregnant women.MethodsMaternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model.Outcome measuresMMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI.ResultsMMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC.ConclusionsMaternal mortality in India’s EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth.

The Effect of Socioeconomic Status on All-Cause Maternal Mortality: A Nationwide Population-Based Cohort Study

Improving maternal health is one of the 13 targets of Sustainable Development Goal 3; consequently, preventing maternal death, which usually occurs in women’s prime productive years, is an important issue that needs to be addressed immediately. This study examines the association between socioeconomic status and all-cause maternal mortality in South Korea and provides evidence of preventable risk factors for maternal death. For this population-based retrospective cohort study, data on 3,334,663 nulliparous women were extracted from the Korean National Health Insurance Service database between 2003 and 2018. The outcome variables were all-cause maternal mortality within six weeks and a year after childbirth. A log-binomial regression model determined the association between maternal mortality and income-level adjusted covariates. Women with lower income levels had higher risk of maternal death within six weeks (risk ratio (RR) = 2.42, 95% confidence interval (CI) = 1.65–3.53) and within one year (RR = 1.83, 95% CI = 1.47–2.28), especially those who were aged 35–39 years, lived in rural areas, delivered via cesarean section, and had maternal comorbidities. The study identifies a significant relationship between South Korean primiparas’ socioeconomic status and maternal death within six weeks or one year after childbirth, suggesting interventions to alleviate the risk of maternal death.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study.

IntroductionWhile reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.MethodsA pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.ResultsThe results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.ConclusionMMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Desk review of maternal death in Liberia, epidemiological week 1-52, 2016

Introduction : maternal death is the death of a woman while pregnant or within 42 days after delivery or termination of pregnancy, irrespective of site and duration of pregnancy and not from incidental causes. Globally, about 830 women die daily from pregnancy-related complications with postpartum hemorrhage being the leading cause. Liberia maternal mortality is one of the highest in the world with 1072 per 100,000 live births. A descriptive analysis of maternal death data was conducted to inform interventions. Methods : Liberia is located in West-Africa with an estimated population of 4.1 million. It has 15 counties with 745 health facilities. A significant proportion of its communities are hard to reach. The Ebola outbreak in 2014 almost led to the collapse of the health system. We reviewed all maternal surveillance data and maternal deaths audit forms submitted to Ministry of Health from the Counties for Epidemiological week 1-52, 2016. Descriptive analyses were done using excel spread sheet. Results : a total of 302 maternal deaths were recorded in 2016. Age 16 -19 years accounted for the highest number of maternal deaths with 64 (21%). Montserrado County had the highest number of maternal deaths with 73 (24%). Most maternal deaths occurred at the health facility, 204 (81%) with postpartum hemorrhage, 93 (31%) being the leading cause followed by postpartum sepsis, 53 (18%). Highest number 34(12%) of maternal deaths was recorded in April and June. Conclusion : teenagers are at high risk of dying from pregnancy-related complications. Postpartum hemorrhage being the leading cause of deaths was probably due to lack of access to high quality care and specialized emergency services (Surgery, Blood Transfusion etc.). Maternal deaths in health facilities are probably due to the poor healthcare and late referral. Analytic studies need to be conducted to access the actual risk factors for maternal deaths in Liberia.

Risk Factors and Newborn Outcomes Associated With Maternal Deaths in the UK From 2009 to 2013: A National Case-control Study

(BJOG. 2016;123:1654–1662) Studies have identified several factors associated with the progression of serious pregnancy complications to maternal death, including medical comorbidities, inadequate antenatal care, and sociodemographic factors. However, identification of differences between the normal pregnant population and those who die from complications during pregnancy or childbirth could be valuable when working to update and improve current pregnancy care pathways focused on the management and/or prevention of risks and complications during pregnancy and childbirth. This current study aimed to determine the risk factors for maternal deaths from direct and indirect causes in the UK between 2009 and 2013 as well as any adverse fetal and newborn outcomes associated with the deaths.

High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy

Mortality in the postpartum period may be impacted by antiretroviral therapy (ART) received in pregnancy, and whether ART is continued in the postpartum period. HIV-infected and HIV-uninfected mothers were enrolled within 48 h of delivery at five public hospital maternity wards throughout Botswana and followed for 24 months. Maternal deaths were reported by one of the approved contacts given by the mother at enrollment. Detailed information on the cause of death was not available. Risk factors for 24-month mortality were assessed using Cox proportional hazard models. From February 2012 to March 2013, 3000 mothers (1499 HIV infected and 1501 HIV uninfected) were enrolled, and 2985 (99.5%) were followed to 24 months or death, or until the death of their child. There were 26 total maternal deaths through 24 months postpartum [439 per 100,000 person-years (p-y)], 22 among HIV-infected women (758 per 100,000 p-y) and 4 among HIV-uninfected women (132 per 100,000 p-y). Maternal HIV-infection (aHR 5.0, 95% CI 1.6-15.2) and infant birth injury (aHR 3.8, 95% CI 1.3-11.4) were independent risk factors for maternal death. Universal ART in pregnancy became the standard-of-care after June 2012, and 978 (65%) women received ART in pregnancy; by 24 months postpartum or end of follow-up, 1148 (79%) had started ART overall. There was no significant difference in 24-month mortality among HIV-infected women who took ART in pregnancy and continued throughout the follow-up period compared with HIV-infected women who took ART or zidovudine in pregnancy and stopped postpartum (aHR 0.6, 95% CI 0.2-1.7). Despite high uptake of ART in pregnancy and postpartum, women with HIV infection in Botswana are five times more likely to die than HIV-uninfected women in the 24 months postpartum.

Factors associated with maternal mortality at advanced maternal age: a population-based case-control study.

ObjectiveThis study aimed to examine the factors associated with maternal mortality among women aged ≥35 years.DesignUnmatched population based case–control study.SettingUnited Kingdom.PopulationBetween 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE‐UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005–2012).MethodsRisk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis.Main outcome measuresOdds ratios and 95% confidence intervals associated with maternal death.ResultsFive factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13–3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79–63.45), medical co‐morbidities (aOR 5.92, 95% CI 3.56–9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23–3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02–1.22).ConclusionAge was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age.Tweetable abstractSmoking is a risk factor for maternal death for those aged over 35 years.

Risk Factors of Maternal Death in Jimma University Specialized Hospital: A Matched Case Control Study

Background: Maternal death has devastating effects on the family she leaves behind and country level. Most of the literatures in our country are reviews of maternal death which are unable to determine the predictors of maternal death and do not consider change of time since there is variation in care given and did not identify timing of death. Objective: To assess risk factors of maternal death in Jimma University specialized hospital, Southwest Ethiopia from January 2010 to December 2014. Methods: A time matched case control study was conducted on 600 charts, 120 cases and 480controls. Data was collected using checklist adapted from maternal death surveillance review of Ethiopia guide line. Data were entered into epi data 3.1 and exported to Stata 13 for analysis. Conditional logistic regression was done to identify the independent predictors of maternal death. The adjusted matched odds ratio with the 95% confidence interval was reported and statistical significance was declared at p =<0.05. To ensure confidentiality only code was written on the check list. Result: More than two third (68%) of death occurred during post-partum period. Predictors of maternal death include: age group of 20 – 34 (AMOR= 0.299, 95% CI (0.113, 0.792)), being from rural area (AMOR = 2.594, 95%CI(1.001,6.726)), prolonged labour (AMOR=37.141, 95%CI(13.296, 103.750)), comorbidities (AMOR=9.631,95%CI(3.135, 29.588), referred cases from health center (AMOR=4.011, 95% CI (1.113, 14.464) and other health institution (AMOR=6.029, 95%CI(1.565, 24.626)). Conclusion: Duration of labour, age, comorbidities, residence and referral were the major factors that affect maternal death.

Survey of Nutritional Status and Health Behavior of Pregnant Women in Bontomate’ne Health Center District Jeneponto

Background: Maternal mortality is a global health problem, and generally occurs mainly in developing countries. The main causes of maternal mortality still include bleeding, eclampsia and infections which contribute about 60% of total maternal deaths. Interventions to reduce the number of maternal deaths is pretty much done, especially in improving the nutritional status and health behavior of pregnant women, but have not yielded optimal results.Aim: This study aimed to determine the nutritional status and health behavior of pregnant women at health centers Bontomate'ne Jeneponto.Methods: This study uses survey design analytic descriptive approach. The population was all pregnant women in the working area Bontomate'ne health center with 189 people. All the population census or taken by total sampling. Data obtained through direct interviews and observations by using a questionnaire.Results: The results showed that normal nutritional status of pregnant women as much as 85.1% and maternal nutritional status category KEK as much as 14.9%. Knowledge of pregnant women about the risk factors of maternal death, danger signs of pregnancy, the importance of antenatal care (ANC), planning a pregnancy and a safe delivery and post natal care (PNC) is categorized as less as much as 90.1%, and the mother's knowledge enough category only 9.9%. Pregnant women who have a positive attitude by 71.3% and amounted to 28.7% negative. Actions poor pregnant women as much as 34.7% and the capital measures both categories as much as 65.3%.Conclusion: Nutritional status and health behavior of pregnant mothers can provide chances for the occurrence of maternal deaths. Suggested the need to conduct needs to conduct education and training to build the knowledge and experience of pregnant women about the nutritional status and health behavior was good with involving the active participation of health workers, community, family, mother and husband.

Ten years trend in maternal mortality at Kilimanjaro Christian Medical Center Tanzania, 2003–2012: A descriptive retrospective tertiary hospital based study

To determine the trend, causes and characteristics of maternal deaths in a tertiary hospital in Northern Tanzania. A descriptive retrospective review of hospital based maternal death data that occurred at Kilimanjaro Christian Medical Center (KCMC) between the years 2003–2012. Descriptive statistics were used to summarize the socio-demographic characteristics, causes and risk factors for maternal deaths using STATA version 12. Yearly maternal mortality ratio (MMR) was calculated to estimate the trend over years under the review. Between years 2003–2012, a total of 34 953 live deliveries and 172 maternal deaths were recorded at KCMC, giving an overall MMR of 492.1/100 000 live deliveries. Direct causes accounted for 107 (62.2%) of maternal deaths, indirect causes 49 (28.5%) and 16 (9.3%) were due to both direct and indirect causes. Hemorrhage was the overall leading cause of maternal death, accounting for 33 (19.2%) of mortality, followed by hypertensive disorders in pregnancy 31 (18.0%). HIV/AIDS and Heart diseases accounted for 8.7% and 6.4% of maternal deaths, and were the leading causes of indirect maternal deaths by contributing 31% and 22% respectively. Majority 67 (38.9%) of deaths were attributed to type II delay followed by type I delay 59 (34.3%). MMR is still very high in northern Tanzania with hemorrhage and hypertensive diseases the major preventable causes of deaths. Efforts must be made at the community, lower and tertiary health facilities to improve risk detection, management of risk cases to prevent severe forms of diseases and ensure timely referrals.

Risk factors for maternal death revisited.

For many years the UK Confidential Enquiry into Maternal Deaths (CEMD) has reported increased risks of pregnancy-associated death in certain groups of women, such as older mothers and substance abusers. The CEMD, however, lacks a control group, so these conclusions have had to be based on comparisons with data from other sources, e.g. the Office for National Statistics or Hospital Episode Statistics. Comparison between deaths and ‘near miss’ events became possible after the UK Obstetric Surveillance System (UKOSS) was established to study uncommon disorders of pregnancy. Conditions such as eclampsia and pulmonary embolism feature in reports from both CEMD and UKOSS, allowing researchers to compare women who died and those who survived. Kayem et al. (PLoS ONE 2011;6:e29077) found that the risk of death was increased by older age, black ethnicity, obesity and unemployment. In a similar, larger study, Nair et al. (BJOG. 2015;122:653-62) identified six risk factors, such as inadequate use of antenatal care, which together accounted for 70% of the increased risk of death. UKOSS also collects details on controls—one or more women delivering in the same hospital immediately before the near-miss case was delivered. These now provide an opportunity for the long-awaited comparison between women who died and women with uncomplicated pregnancies. In this issue, Nair et al. compare 383 maternal deaths reported to MBRRACE-UK in 2009–2013 and 1516 controls from UKOSS studies between 2010 and 2012. The two groups, drawn from the same national population over similar time periods, are as closely comparable as possible. This study is ground-breaking in several ways. First, it combines data from two well-established and accurate surveillance programmes. Their reliability contrasts with much of our global information on maternal mortality, which is derived either from estimates by international bodies or from national registers—notoriously subject to under-reporting. Secondly, the study includes maternal deaths from both direct and indirect causes. This is important because in the UK indirect deaths have outnumbered direct deaths since 1997. Worldwide, however, direct causes still account for 73% of maternal deaths (Say et al. Lancet Global Health. 2014;2:e323-33). This difference is one example of why lessons for reducing maternal mortality must be learned at a national level. Thirdly, the study challenges our ideas about risk factors. Of the 13 factors examined, only seven were found to be associated with maternal mortality. They include inadequate utilisation of antenatal care, medical comorbidities and, surprisingly for the UK, anaemia. Missing from the list are ethnicity, parity, body mass index and cigarette smoking, all of which were significant on initial analysis but not after adjustment for other factors. The clinical implications of this study are important. It confirms the risks associated with unemployment and increasing maternal age. The authors point out that women from black African backgrounds should still be considered high risk, but their analysis strongly suggests that the excess mortality in this and other at risk groups can be substantially reduced by targeted interventions, such as attention to medical co-morbidities and improved access to antenatal care. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case-control study.

ObjectivesTo identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK.DesignUnmatched case–control analysis.SettingAll hospitals caring for pregnant women in the UK.PopulationComprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life‐threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS).MethodsMultivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.OutcomesOdds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk.ResultsSeven factors, of 13 examined, were independently associated with increased odds of maternal death: pre‐existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29–11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14–11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33–2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61–111.94), substance misuse (aOR 12.21; 95% CI 2.33–63.98), unemployment (aOR 1.81; 95% CI 1.08–3.04) and maternal age (aOR 1.06; 95% CI 1.04–1.09). There was a four‐fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died.ConclusionThis study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio‐economic inequalities in maternal death in the UK.Tweetable abstractMedical comorbidities and socio‐economic inequalities are important risk factors for maternal death in the UK.