scholarly journals Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014–2018

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244984
Author(s):  
Godwin O. Akaba ◽  
Obiageli E. Nnodu ◽  
Nessa Ryan ◽  
Emmanuel Peprah ◽  
Teddy E. Agida ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Classification System ◽  
Maternal Mortality Ratio ◽  
Evidence Based ◽  
Continuous Variables ◽  
Maternal Deaths ◽  
Hypertensive Disorders ◽  
Obstetric Haemorrhage ◽  
Mortality Ratio ◽  
Underlying Causes

Background Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. Objectives The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. Methods This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). Results The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25–34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. Conclusion Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria.

scholarly journals Maternal mortality at a tertiary health care: a retrospective study

2018 ◽  
Vol 7 (5) ◽  
pp. 1773
Author(s):  
Sona Singh ◽  
Nagendra Singh ◽  
Jagriti Kiran Nagar ◽  
Sarvesh Jain
Keyword(s):  
Retrospective Study ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Age Group ◽  
Maternal Deaths ◽  
Medical College ◽  
Tertiary Centre ◽  
Hypertensive Disorders ◽  
Mortality Ratio ◽  
One Year

Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy from any cause related to or aggravated by the pregnancy, but not from accidental or incidental causes. The aim of this study is to find out the causes of maternal mortality and the complications leading to maternal death.Methods: A retrospective study was conducted by reviewing the hospital records to study the maternal deaths and complication leading to maternal death over the period of one year from July 2016 June 2017 in the Department of Obstetrics and Gynecology, Bundelkhand Medical College, and associated hospital Sagar, Madhya Pradesh. All the maternal deaths were scrutinized for various aspects likely to be related to death such as age, locality of residence, antenatal care, admission death interval and the cause of death.Results: The maternal mortality ratio in the present study is 292.33/100,000 live births. There were 28 maternal deaths out of 9578 live birth during the study period. The majority of deaths occurred in the 20-30 age group. hemorrhage (32.14%) and hypertensive disorders (14.28%) are two most common direct cause of maternal deaths. 42.85% of maternal deaths occurred within the first twenty-four hours of admission. Post-operative and post abortal sepsis, amniotic fluid embolism and pulmonary embolism are other direct causes. Indirect causes of maternal deaths account for 21.42%. Severe anemia was the leading indirect causes of maternal deaths.Conclusions: Hemorrhage, hypertensive disorders, and anaemia remain the major cause of maternal deaths. Delay in decision making, provision of treatment and referral to tertiary centre contributed higher maternal mortality. This requires more efforts to recognize the direct and indirect causes of maternal deaths.

scholarly journals Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0157495 ◽  
Author(s):  
Hector Lamadrid-Figueroa ◽  
Alejandra Montoya ◽  
Jimena Fritz ◽  
Marisela Olvera ◽  
Luis M. Torres ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Evidence Based ◽  
Maternal Deaths ◽  
Mortality Ratio ◽  
Definition Of

scholarly journals MATERNAL MORTALITY

2009 ◽  
Vol 16 (03) ◽  
pp. 445-553
Author(s):  
SADIA KHAN ◽  
ASMA TANVEER USMANI ◽  
NAILA IFTIKHAR
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Economic Status ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Developed Country ◽  
Mortality Ratio ◽  
Underlying Causes ◽  
One Year ◽  
A Prospective Study

Objective: The women residing in a developing country have 200 times greater risk of suffering from pregnancy and childbirthrelated mortality compared with the women of a developed country. To investigate relevant causes and the determinants of maternal mortalitythrough conducting scientific clinical studies. Methodologies: We conducted a prospective study of maternal deaths in the obstetrics andgynaecology unit of RGH for one year. Period: January 2007 to December 2007. We investigated the socio-demographic variables - includingage, parity, socio-economic status and literacy - along with the social behavior towards the antenatal. We designed standardized data collectingforms to collect data from the confidential hospital notes of the patients. The collected medical data of the patients proved useful in analyzingthe underlying causes and the risk factors behind direct and indirect maternal mortalities. Results: In our unit, we have recorded 28 maternaldeaths during the study period. 24 (86%) deaths are due to the direct causes and 4 (14%) are due to the indirect causes. The leading directcauses are hemorrhage 9 (37.5%), eclampsia 7 (29%), septicemia 5 (21%) and anaesthesia complications 2 (8%). Similarly, the distributionof indirect causes is: blood transfusion reactions 2 (50 %), hepatic failure 2 (50 %), Consequently, crude maternal mortality rate can beextrapolated at 645 per 100,000 maternities and maternal mortality ratio at 659 per 100,000 live births. The socio demographics of the deadmothers are: 16 (57%) patients in the age group of 25-35 years, 13 (52%) are multiparas (G2-G4) and 10 (36%) are grandmulti para i.e. G5and above. Moreover, 13 (46%) of them expired at term. The majority of them is illiterate and belongs to lower socio-economic group. 14 (42%)mothers have not received antenatal care and just 4 (15%) of them have received antenatal care from RGH or other hospital. 23 (92%) patientshave been suffering from anemia and we received 15 (54%) of them in a critical state with the hospital stay of less than 12 hours. C o n c l u s i o n :In our study hemorrhage and hypertensive disorders of pregnancy are the leading causes of maternal deaths. We argue that most of thesematernal deaths could have been possibly avoided by periodic interventions during the pregnancy, child birth and the postpartum period.

scholarly journals Improving the Metrics and Data Reporting for Maternal Mortality:A Challenge to Public Health Surveillance and Effective Prevention

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
James Studnicki ◽  
David Reardon ◽  
Donna Harrison ◽  
John Fisher ◽  
Ingrid Skop
Keyword(s):  
Maternal Mortality ◽  
Pregnancy Outcome ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Maternal Mortality Ratio ◽  
Mortality Data ◽  
Evidence Based ◽  
Maternal Deaths ◽  
Effective Prevention ◽  
Mortality Ratio

AbstractBackgroundThe current measuring metric and reporting methods for assessing maternal mortality are seriously flawed. Evidence-based prevention strategies require consistently reported surveillance data and validated measurement metrics.Main BodyThe denominator of live births used in the maternal mortality ratio reinforces the mistaken notion that all maternal deaths are consequent to a live birth and, at the same time, inappropriately inflates the value of the ratio for subpopulations of women with the highest percentage of pregnancies ending in outcomes other than a live birth. Inadequate methods for identifying induced or spontaneous abortion complications assure that most maternal deaths associated with those pregnancy outcomes are unlikely to be attributed. Absent the ability to identify all maternal deaths, and without the ability to differentiate those deaths by specific pregnancy outcomes, existing variations in pregnancy outcome-specific maternal deaths are masked by the use of an aggregated (all outcome) numerator. Under these circumstances, clear and accurate data is not available to inform evidence-based preventive strategies. As the result, algorithms applied for analyzing maternal mortality data may return distorted results.ConclusionImprovement in the effectiveness of maternal mortality surveillance will require: mandatory certification of all fetal losses; linkage of death, birth and all fetal loss (induced and natural) certificates; modification of the structure of the overall maternal mortality ratio to enable pregnancy outcome-specific ratio calculations; development of the appropriate ICD codes which are specific to induced and spontaneous abortions; education for providers on identifying and reporting early pregnancy losses; and, flexible information systems and methods which integrate these capabilities and inform users. 

scholarly journals Maternal Death Review at a Tertiary Hospital in Ethiopia

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Matiyas Asrat Shiferaw ◽  
Delayehu Bekele ◽  
Feiruz Surur ◽  
Bethel Dereje ◽  
Lemi Belay Tolu
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Maternal Mortality Ratio ◽  
Tertiary Hospital ◽  
Hypertensive Disorders Of Pregnancy ◽  
Contributing Factors ◽  
Double Burden ◽  
Maternal Deaths ◽  
Hypertensive Disorders ◽  
Mortality Ratio

BACKGROUND፡ There is conflicting data on the rate and trends of maternal mortality in Ethiopia. There is no previous study done on the magnitude and trends of maternal death at Saint Paul's Hospital, an institution providing the largest labor and delivery services in Ethiopia. The objective of this study is to determine the magnitude, causes and contributing factors for maternal deaths in the institution.METHODS: We conducted a retrospective review of maternal deaths from January 2016 to December 2017. Data were analyzed using SPSS version 20.RESULTS: The maternal mortality ratio of the institution was 228.3 per 100,000 live births. Direct maternal death accounted for 90% (n=36) of the deceased. The leading causes of the direct maternal deaths were hypertensive disorders of pregnancy (n=13,32.5%), postpartum hemorrhage (n=10, 25%), sepsis (n=4, 10%), pulmonary thromboembolism (n=3, 7.5%) and amniotic fluid embolism (n=3, 7.5%).CONCLUSION: The maternal mortality ratio was lower than the ratios reported from other institutions in Ethiopia. Hypertensive disorders of pregnancy and malaria were the leading cause of direct and indirect causes of maternal deaths respectively. Embolism has become one of the top causes of maternal death in a rate like the developed nations. This might show the double burden of embolism and other causes of maternal mortality that developing countries might be facing.

scholarly journals “Near Miss” Obstetric Events and Maternal Deaths in a Tertiary Care Hospital: An Audit

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Roopa PS ◽  
Shailja Verma ◽  
Lavanya Rai ◽  
Pratap Kumar ◽  
Murlidhar V. Pai ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Live Births ◽  
Hypertensive Disorders ◽  
Mortality Index ◽  
Mortality Ratio

Objectives. (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index. (2) To compare the nature of near miss events with that of maternal mortality. (3) To see the trend of near miss events.Design. Audit.Setting. Kasturba Hospital, Manipal University, Manipal, India.Population. Near miss cases & maternal deaths.Methods. Cases were defined based on WHO criteria 2009.Main Outcome Measures. Severe acute maternal morbidity and maternal deaths.Results. There were 7390 deliveries and 131 “near miss” cases during the study period. The Maternal near miss incidence ratio was 17.8/1000 live births, maternal near miss to mortality ratio was 5.6 : 1, and mortality index was 14.9%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hemorrhage was the leading cause (44.2%), followed by hypertensive disorders (23.6%) and sepsis (16.3%). Maternal mortality ratio (MMR) was 313/100000 live births.Conclusion. Hemorrhage and hypertensive disorders are the leading causes of near miss events. New-onset viral infections have emerged as the leading cause of maternal mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

scholarly journals Trends on Maternal Mortality in the Republic of Benin and Comparison with the Neighboring Countries

2020 ◽  
Vol 13 (2) ◽  
pp. 197-216
Author(s):  
Romeo Konnon ◽  
Said Semyatov ◽  
Muhammednazar Soyunov ◽  
Zalina Sokhova ◽  
Tatevik Zulumyan
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
High Rate ◽  
Maternal Deaths ◽  
Live Births ◽  
Obstetric Haemorrhage ◽  
Mortality Ratio ◽  
Republic Of Benin ◽  
The Republic ◽  
The Government

The maternal mortality ratio in the Republic of Benin in 2015 was still high – 405 per 100,000 live births. The delay in consultation and timely treatment, unavailability of medical facilities and lack of skilled care are the principal factors contributing to maternal deaths in Benin. Consequently, the rate of such preventable causes of maternal deaths like obstetric haemorrhage (38.40 percent and pre-eclampsia/eclampsia (14.30 percent) remains high in the country, and even HIV continued being one of the indirect causes of maternal deaths in 2017 – one percent. High rate of complications associated with pregnancy and birth in adolescent girls is another cause of maternal deaths in the Republic of Benin. Despite the efforts of the Government aimed at improving health care, it is unlikely that we will achieve the United Nations Sustainable Development Goals 3.1. – the reduction of maternal mortality ratio to less than 70 per 100,000 live births by 2030.

scholarly journals An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa

2017 ◽  
Vol 32 (2) ◽  
pp. 73-76
Author(s):  
Sam T. Ntuli ◽  
Mabina Mogale ◽  
Francis L.M. Hyera ◽  
Shan Naidoo
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Tertiary Hospital ◽  
Limpopo Province ◽  
Hospital Death ◽  
Maternal Deaths ◽  
Live Births ◽  
Obstetric Haemorrhage ◽  
District Hospitals ◽  
Mortality Ratio

Objective: To understand the elements influencing the maternal deaths in the Limpopo province, South Africa.Methods: A retrospective review of all maternal deaths which occurred at the Pietersburg Hospital, Limpopo province was done over a five-year period (January 2011 to December 2015). The hospital death register was used to collate a list of maternal deaths occurring during the study period. The medical records of maternal deaths were reviewed. The total deliveries and live births for each year were obtained from the delivery registers. The data collected included maternal age, parity, referring facility, date of admission, date and time of death, ward where death occurred, and cause of death.Results: There were 14 685 live births and 232 maternal deaths between 2011 and 2015, resulting in an institutional Maternal Mortality Ratio (iMMR) of 1579/100 000 live births. The mean age of the patients was 29 years. Forty-three per cent of deaths occurred within 24 hours of admission, 35% died in ICU and 89% were referred from regional and district hospitals and community health centres. Of the referred patients, 83% were from district hospitals. Obstetric haemorrhage and pre-eclampsia, or eclampsia, were the main causes of death.Conclusion: The iMMR at Pietersburg Hospital remains unacceptably high. Most of the maternal deaths are due to obstetric haemorrhage, pre-eclampsia or eclampsia, medical and surgical disorder and non-pregnancy related infections.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

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