International Academy of Perinatal Medicine (IAPM) guidelines for screening, prediction, prevention and management of pre-eclampsia to reduce maternal mortality in developing countries

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Vedran Stefanovic
Keyword(s):  
Developing Countries ◽  
High Risk ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Gestational Hypertension ◽  
Calcium Supplementation ◽  
Perinatal Medicine ◽  
Maternal Deaths ◽  
Near Term ◽  
International Academy

Abstract Approximately 800 women die from pregnancy or childbirth-related complications around the world every day, 99% of which occur in developing countries. In majority of cases deaths are related to pre-eclampsia and eclampsia. The purpose of new adjusted and simplified IAPM guidelines is specifically lowering maternal mortality by decreasing preventable deaths in developing countries (particularly in remote rural areas) by using rather cheap medicines used to control chronic and gestational hypertension, prevent pre-eclampsia in high-risk pregnancies and treat severe pre-eclampsia and eclampsia. IAPM guidelines should be implemented and evaluated in each developing country respecting specific problems, needs and resources. It is of essential importance to: 1. Identify specific high-risk pregnancies, 2. Commence timely appropriate ASA and calcium supplementation, 3. Organize basic antenatal care and adequate referral of pregnancies with early onset of pre-eclampsia to the appropriate institutions and ensure induction of labour in well-equipped delivery facility for women with near-term and term pre-eclampsia 4. Ensure Magnesium sulphate availability to prevent severe pre-eclampsia and eclampsia-related maternal deaths, and 5. Identify specific barriers for implementation of these guidelines and correct them accordingly. Only by systematic implementations of these guidelines, we may have a chance to decrease the mortality of pre-eclampsia an its complications as a killer number one of mothers in developing countries.

scholarly journals Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Vedran Stefanovic
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Meta Analysis ◽  
Perinatal Care ◽  
Substantial Improvement ◽  
Global Strategy ◽  
Perinatal Medicine ◽  
Technological Advances ◽  
Women's Role

Abstract Despite substantial improvement in reducing maternal mortality during the recent decades, we constantly face tragic fact that maternal mortality (especially preventable deaths) is still unacceptably too high, particularly in the developing countries, where 99% of all maternal deaths worldwide occur. Poverty, lack of proper statistics, gender inequality, beliefs and corruption-associated poor governmental policies are just few of the reasons why decline in maternal mortality has not been as sharp as it was wished and expected. Education has not yet been fully recognized as the way out of poverty, improvement of women’s role in the society and consequent better perinatal care and consequent lower maternal mortality. Education should be improved on all levels including girls, women and their partners, medical providers, religious and governmental authorities. Teaching the teachers should be also an essential part of global strategy to lower maternal mortality. This paper is mostly a commentary, not a systematic review nor a meta-analysis with the aim to rise attention (again) to the role of different aspects of education in lowering maternal mortality. The International Academy of Perinatal Medicine should play a crucial role in pushing the efforts on this issue as the influential instance that promotes reflection and dialog in perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of this specific problem of huge magnitude. The five concrete steps to achieve these goals are listed and discussed.

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.

scholarly journals Universal Maternal Rights: A Matter of Life and Death

2021 ◽  
Author(s):  
Alicia Ryan
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Obstetric Care ◽  
Maternal Deaths ◽  
Scientific Methods ◽  
Life And Death ◽  
The World ◽  
Positive Effect ◽  
Multiple Obstacles ◽  
Maternal Rights

Childbirth has been a part of our lives since the beginning of time. Without the process none of us would be alive today. So why is it that maternal mortality remains one of the greatest inequities in the world? To date, approximately 500, 000 women die annually due to the lack of appropriate prenatal and obstetric care. Difficulties arising with childbirth cannot be predicted. However, the way in which we react to a situation can have a lasting, positive effect on the countries and the women who are at risk. The ways in which to help reduce the large number of maternal deaths in developing countries is not complicated and can be achieved if it is made a priority. In conclusion, there are multiple obstacles in regard to succeeding the highest achievable standard of health globally.  With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored. With the education of evolving scientific methods, and the collaboration of humanitarian views, the welfare and health of women and their children, can be internationally restored.

scholarly journals Baseline Data on Trend of Maternal Mortality in Tanzania using Administrative Data and its Policy Implication. 2018 Report

2020 ◽  
pp. 5-12 ◽  
Author(s):  
Dr. Ahmad Mohamed Makuwani ◽  
Dr. Phineas Ferdinand Sospeter ◽  
Dr. Leonard Subi ◽  
Dr. Mukome Anthony Nyamhagatta ◽  
Dr. Ntuli Kapologwe ◽  
...  
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Confidence Intervals ◽  
Disease Surveillance ◽  
Vital Statistics ◽  
Maternal Deaths ◽  
Civil Registration ◽  
The Past ◽  
Sisterhood Method ◽  
Surveillance And Response

Background: Globally, Civil Registration, and Vital Statistics is the recommended method to track births and deaths. This system is weak in developing countries, including Tanzania. Other systems that may be used to report deaths, especially maternal mortality include integrated Disease Surveillance and Response (IDSR) and DHIS 2. Tanzania has been using Demographic and Health Survey to track maternal deaths from as early as 2000. This study uses a sisterhood method which is conducted every five years, tracking events of the past ten years. It collects maternal deaths related from sisters of the same mother from sampled 10,000 households out of 11,000,000 available in Tanzania. The methodology uses wide confidence intervals, which affect its reliability. Therefore, the presented data is the outcome of tracking maternal deaths data using routine system from health facilities and communities in Tanzania Mainland.

scholarly journals Evaluation of maternal mortality and their factors in GMCH, Aurangabad, India

2018 ◽  
Vol 7 (3) ◽  
pp. 879
Author(s):  
Ganesh Balasaheb Bharaswadkar ◽  
Murlidhar L. Kurtadikar
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Community Education ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Maternal Deaths ◽  
Infective Hepatitis

Background: Analysing the factors related to maternal mortality is very important as they reflect the socioeconomic status and health care facility availabilities of the country. This study is aimed to analyse the epidemiological aspects and different causes of maternal death and evaluation of preventable factors and unavoidable factors if any causing maternal death.Methods: The retrospective study was carried out at GMCH, Aurangabad during the period from February 2002 to January 2004. All the data related to epidemiological factors and causes of maternal mortality was recorded and analyzed.Results: There were 33 maternal deaths during the study period. The mean maternal mortality rate was 211 per 1,00,000 total births. Maximum maternal deaths were reported at the age group of 26-30 years (36.1%), in primiparous women (46.8%) and from rural areas (78.38%). Most of the deaths (37.5%) were reported within first 24 hours of hospital admission at postpartum stage (87.5%). 84.37% of maternal deaths were due to direct causes. And toxemia of pregnancy (39.5%) was major direct cause. Anaemia and infective hepatitis constitutes for 9.3% each for the indirect causes maternal death.Conclusion: Most maternal deaths can be preventable by multidisciplinary approaches involving mass community education, improving sanitation, early referrals to tertiary care centres and by providing health care facilities in rural areas.

scholarly journals Maternal mortality in tertiary care hospital: a 2-year review

2018 ◽  
Vol 8 (1) ◽  
pp. 184
Author(s):  
Juhi Ankit Patel ◽  
Kanaklata D. Nakum ◽  
Aditi Vithal ◽  
Mayank R. Lunagariya
Keyword(s):  
Maternal Mortality ◽  
Low Socioeconomic Status ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Epidemiological Data ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Mortality Ratio ◽  
Set Up

Background: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement.Methods: This was a 2-year retrospective study. Epidemiological data was collected from the Last 2 years of Facility Based Maternal Death Review Form. Maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed.Results: A total of 72 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years (40.27%), multiparous women (70.83%), women from rural areas (65.27%), illiterate women, unbooked patients (83.33%), and patients of low socioeconomic status. Direct causes accounted for 62.4% of maternal deaths where as 37.4% of maternal deaths were due to indirect causes.Conclusions: There is a wide scope for improvement as a large proportion of the observed deaths could be preventable.

Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1414-1422
Author(s):  
Cande V. Ananth ◽  
Justin S. Brandt ◽  
Jennifer Hill ◽  
Hillary L. Graham ◽  
Sonal Grover ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Maternal Mortality ◽  
Birth Cohort ◽  
White Women ◽  
Gestational Hypertension ◽  
The United States ◽  
Chronic Hypertension ◽  
Maternal Deaths ◽  
Live Births

We evaluated the contributions of maternal age, year of death (period), and year of birth (cohort) on trends in hypertension-related maternal deaths in the United States. We undertook a sequential time series analysis of 155 710 441 live births and 3287 hypertension-related maternal deaths in the United States, 1979 to 2018. Trends in pregnancy-related mortality rate (maternal mortality rate [MMR]) due to chronic hypertension, gestational hypertension, and preeclampsia/eclampsia, were examined. MMR was defined as death during pregnancy or within 42 days postpartum due to hypertension. Trends in overall and race-specific hypertension-related MMR based on age, period, and birth cohort were evaluated based on weighted Poisson models. Trends were also adjusted for secular changes in obesity rates and corrected for potential death misclassification. During the 40-year period, the overall hypertension-related MMR was 2.1 per 100 000 live births, with MMR being almost 4-fold higher among Black compared with White women (5.4 [n=1396] versus 1.4 [n=1747] per 100 000 live births). Advancing age was associated with a sharp increase in MMR at ≥15 years among Black women and at ≥25 years among White women. Birth cohort was also associated with increasing MMR. Preeclampsia/eclampsia-related MMR declined annually by 2.6% (95% CI, 2.2–2.9), but chronic hypertension–related MMR increased annually by 9.2% (95% CI, 7.9–10.6). The decline in MMR was attenuated when adjusted for increasing obesity rates. The temporal burden of hypertension-related MMR in the United States has increased substantially for chronic hypertension–associated MMR and decreased for preeclampsia/eclampsia-associated MMR. Nevertheless, deaths from hypertension continue to contribute substantially to maternal deaths.

scholarly journals Maternal mortality in a tertiary care centre in North India: a retrospective study

2017 ◽  
Vol 6 (12) ◽  
pp. 5559
Author(s):  
Prachi Sarin Sethi ◽  
Sujata Sharma ◽  
Indu Chawla
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Rural Areas ◽  
Tertiary Care ◽  
Care Facility ◽  
North India ◽  
World Health ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Maternal Deaths

Background: The World Health Organization (WHO) estimates that, of 536,000 maternal deaths occurring globally each year, 136,000 take places in India. Maternal death has serious implications to the family, the society and the nation. It deprives the surviving infant of mother's care. This study was done to assess maternal mortality in a tertiary care centre in north India where large numbers of patients are referred from the peripheral centers and the rural parts. This study was done to assess the causes of maternal mortality and suggest remedial measures to reduce the same. Objective of present study was to assess the causes of maternal death over a period of one year at G.M.C Amritsar, India.Methods: A retrospective hospital based study of 22 maternal deaths over a period of 1 year from June 2012 to June 2013. The information regarding demographic profile and reproductive parameters were collected and results were analyzed.Results: Over the study period, there were 22 deaths and 7272 live births (Majority were referral from other districts all over Punjab). Most common direct cause of maternal mortality was haemorrhage and anemia was the most common indirect cause. Most maternal deaths were seen in patients from rural areas, unbooked, illiterate patients and patients from low socioeconomic status.Conclusions: Proper health education should be given to the women; early registration of antenatal cases should be done which allows for rapid diagnosis and treatment of high risk cases. Also constructing a well equipped health care facility with trained staff and prompt transport facilities for early referral can bring down the maternal mortality rate in our country.

scholarly journals Differences in maternal mortality between urban and rural areas: Analysis of  Maternal Mortality based in Jinan, China in 1995- 2018

2019 ◽  
Author(s):  
Lihua Zhang ◽  
Tingting Zhen ◽  
Qinyou Meng ◽  
Shimin Yang ◽  
Jiaxue Pan ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Death ◽  
Rural Areas ◽  
Urban Areas ◽  
Maternal Deaths ◽  
Policy Makers ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
The Difference ◽  
Urban And Rural Areas

Abstract Background: Although a large number of studies have shown that maternal mortality in rural areas is higher than that in urban areas, few reports discussed about the detailed situation and the behind causes. Here, we summarized the maternal mortality from 1995 to 2018 in Jinan and the reason behind it was deeply discussed. It is expected to reveal the difference and its behind reasons, thus providing a basis for policy makers to develop interventions. Methods: Data about maternal mortality in the selected city from 1995 to 2018 were collected through the local maternal and child health care network. Maternal death age, maternal death delivery location, maternal death location, number of pregnancies, number of deliveries and maternal death causes were analyzed. The composition ratio of above factors were compared in order to indicate the differences between rural areas and urban areas. Results: The study showed that 75.34% of maternal deaths in urban areas occurred in tertiary hospitals, which were 2.13 times higher than that in rural areas(P<0.05). 16.67% of maternal deaths in rural areas delivered in primary hospitals, which were 12.17 times higher than that in urban areas (P<0.05) . The main cause of death in rural areas were attributed to direct obstetrics reasons, which were indirect obstetric reasons for urban areas (P<0.05). There was no difference of maternal deaths in the death age, number of births, and number of pregnancies between rural areas and urban areas.(P>0.05) Conclusion: Policy makers should focus on the construction of medical institutions in rural areas, the improvement of rescue capabilities in rural areas and the convenience of transport in rural areas in order to narrow the gap between rural and urban areas. Key words: Maternal Mortality; Differences between urban and rural areas; China

scholarly journals A temporal analysis of maternal deaths in some selected health facilities in Zamfara State, Northwest Nigeria: How far were United Nations Millennium Development Goals (MDG) 5 achieved?

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Abdullahi Mohammed Maiwada ◽  
Nor Azlina A Rahman ◽  
Suzanah Abdul Rahman ◽  
Nik Mazlan Mamat ◽  
Tukur A Baba ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Health Facility ◽  
Rural Areas ◽  
Urban Areas ◽  
Maternal Mortality Ratio ◽  
Temporal Analysis ◽  
Health Facilities ◽  
Steady Increase ◽  
Maternal Deaths ◽  
Mortality Ratio

Introduction: The steady increase in maternal deaths in Nigeria is a serious source of concern to policy makers and key stakeholders as one of the major threats to the achievement of the MDGs. Nigeria is reported to have one of the highest maternal mortality ratios in the world. This study was aimed at examining the challenges confronting the achievement of the MDGs Goals 5 in Zamfara State northwest Nigeria in terms of maternal mortality ratio, causes and frequency of antenatal visits. Methods: Health facility based approach and statistics were used in assessing maternal mortality ratio. Data was collected from health facility records and folders of patients who lost their lives due to pregnancy and childbirth related illnesses in some selected health facilities in Zamfara State from 2011- 2015. Results: The results showed the highest maternal deaths are in the rural areas 5120/100,000 as compared to 750/100,000 urban health facilities. Haemorrhage was the leading medical cause of maternal death. Others include sepsis, eclampsia, sickle cell anaemia, obstructed labour and abortion. However, there was a significant increase in the number of antenatal care visits from 7.20% to 30.93% within the last five years. However, the maternal mortality rate has increased, though not stable from 735/100,000 in 2011 to 1248/100,000 in 2013 and 930/100,000 in mid-2015. Conclusions: There was an increase in maternal deaths in rural compared to urban areas health clinics despite increased in the attendance of ante natal care visits thus the 5th Millennium Development Goal in Zamfara State not achieved.

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