Confidential enquiry into maternal deaths in the Netherlands, 2006-2018: a retrospective cohort study

Objective: To calculate maternal mortality ratio (MMR) for 2006-2018 in the Netherlands and compare with 1993-2005. Describe women’s and obstetric characteristics, causes of death and improvable factors. Design: Prospective cohort study. Setting: Nationwide. Population: 2,304,271 livebirths. Methods: Analysis of all maternal deaths between January 1st, 2006, and December, 31st, 2018 as reported to and audited by the national Audit Committee Maternal Mortality and Morbidity. Main outcome measures: MMR, causes of death, improvable factors. Results: Overall MMR was 6.2 per 100,000 livebirths, a decrease from 12.1 in 1993-2005 (Odds Ratio (OR) 0.5, 95%CI 0.4-0.6). Women with non-Western ethnic background had a slightly increased MMR compared to Dutch women (MMR 6.5 vs 5.0, OR 1.3, 95%CI 0.9-1.9), and was particularly increased among women with a background from Surinam/Dutch Antilles (MMR 14.7 OR 2.9, 95%CI 1.6 – 5.3). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 172 pregnancy-related deaths within one year postpartum, 103 (60%) had a direct and 69 (40%) an indirect cause. Leading causes within 42 days postpartum were cardiac disease (n=21, 14.8%), hypertensive disorders (n=20, 14.1%) and thrombosis (n=19, 13.4%). For deaths up to one year postpartum, suicide was the third commonest cause (n=20, 11.6%). Improvable factors in care were identified in 76 (47.5%) of all deaths. Conclusions: Maternal mortality halved in 2006-2018 compared to 1993-2005. Unlike before, cardiac disease outnumbered hypertensive disorders as main cause of death. Women with a background from Surinam/Dutch Antilles had a threefold higher risk of death compared to Dutch women.

Download Full-text

Maternal mortality at a tertiary health care: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181576 ◽

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.

Download Full-text

Maternal Mortality: Sharing Experience from Nobel Medical College Teaching Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v7i2.11140 ◽

2014 ◽

Vol 7 (2) ◽

pp. 33-35

Author(s):

S Ghimire

Keyword(s):

Maternal Mortality ◽

Teaching Hospital ◽

Post Partum ◽

Maternal Mortality Ratio ◽

College Teaching ◽

Eastern Region ◽

Safe Abortion ◽

Maternal Deaths ◽

Medical College ◽

One Year

Aims: To analyse causes of maternal deaths and to identify avoidable factors. Methods: This was a retrospective analysis of maternal deaths, during a period of one year from 15th April, 2011-15th April, 2012, at Nobel Medical College Teaching Hospital, Biratnagar in the Eastern Region of Nepal case files and hospital records being the data sources. All the maternal deaths were recorded. Results: In one year study period, out of a total of 2,754 deliveries, there were 8 maternal deaths giving maternal mortality ratio of 310/100,000 live births. Three of them resulted from an induced abortion mishap and five of them were obstetric deaths. Four of the direct obstetric deaths resulted from complications of pregnancy induced hypertension (PIH) of which one case died due to traumatic post partum hemorrhage postpartum hemorrhage (PPH) as a result of torrential bleeding from extensive vaginal wall tear. One indirect obstetric death occurred in a case of twin pregnancy with severe anemia and congestive cardiac failure. Conclusions: Provision of safe abortion services is still not available to many women despite of legalization of abortion in Nepal. Quality antenatal care services would be helpful in avoiding maternal mortality in many situations by detecting and managing medical complications of pregnancy. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11140 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 33-35

Download Full-text

Temporal Evolution of Maternal Mortality: 1980-2019

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1735300 ◽

2021 ◽

Vol 43 (09) ◽

pp. 662-668

Author(s):

Janete Vettorazzi ◽

Edimárlei Gonsales Valério ◽

Maria Alexandrina Zanatta ◽

Mariana Hollmann Scheffler ◽

Sergio Hofmeister de Almeida Martins Costa ◽

...

Keyword(s):

Maternal Mortality ◽

Medical Records ◽

Causes Of Death ◽

Maternal Mortality Ratio ◽

Liver Steatosis ◽

Reproductive Age ◽

Porto Alegre ◽

Maternal Deaths ◽

Live Births ◽

Mortality Ratio

Abstract Objective To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution. Methods Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327). Results After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%). Conclusion Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.

Download Full-text

MATERNAL MORTALITY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.03.2880 ◽

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.

Download Full-text

Maternal Death Review at a Tertiary Hospital in Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v31i1.5 ◽

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.

Download Full-text

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

Journal of Pregnancy ◽

10.1155/2013/393758 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 20

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.

Download Full-text

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

PLoS ONE ◽

10.1371/journal.pone.0244984 ◽

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.

Download Full-text

Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

Reproductive Health ◽

10.1186/s12978-020-00990-z ◽

2020 ◽

Vol 17 (S3) ◽

Author(s):

Melissa Bauserman ◽

Vanessa R. Thorsten ◽

Tracy L. Nolen ◽

Jackie Patterson ◽

Adrien Lokangaka ◽

...

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Maternal Deaths ◽

Middle Income ◽

Maternal Risk ◽

Live Births ◽

Middle Income Countries ◽

Risk Of Death ◽

Increased Risk ◽

Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

Download Full-text

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

BMC Public Health ◽

10.1186/s12889-021-11325-3 ◽

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.

Download Full-text

Comparative analysis of maternal mortality in the Far Eastern and Siberian Federal Districts

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2020-6-117-123 ◽

2020 ◽

Vol 19 (6) ◽

pp. 117-123

Author(s):

T.E. Belokrinitskaya ◽

◽

N.V. Artymuk ◽

O.S. Filippov ◽

E.M. Shifman ◽

...

Keyword(s):

Comparative Analysis ◽

Maternal Mortality ◽

Causes Of Death ◽

Federal District ◽

Siberian Federal District ◽

Obstetric Hemorrhage ◽

Maternal Deaths ◽

Federal Districts ◽

Systematic Development ◽

Far Eastern

Objective. To perform comparative analysis of parameters and structure of maternal mortality (MM) in the Far Eastern Federal District (FEFD) and Siberian Federal District (SFD) in 2014–2019. Materials and methods. The database for analysis was generated using map-based emergency notifications of maternal deaths (69 in FEFD and 180 in SFD). We used methods of descriptive statistics, Pearson's χ2-test, and calculated odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. Between 2014 and 2018, the dynamics of MM in the FEFD and SFD had a one-way trend: it decreased in 2014–2017, but dramatically increased in 2018 primarily due to social factors. In 2019, we observed a significant growth of MM in the FEFD, while the SFD demonstrated a reduction of MM. The most common cause of maternal death in both districts was extragenital diseases. However, there were some differences in the structure of obstetric causes: in FEFD, preeclampsia and obstetric hemorrhage were the most frequent obstetric causes of death, while in SFD, women primarily developed embolism and placental abruption. Conclusion. The dynamics and structure of MM in the FEFD and SFD require management decisions aimed at improving medical care with the consideration of clinical guidelines, organization of continuous audit, systematic development of practical teamwork skills both in simulation training centers and healthcare institutions. Key words: Far Eastern Federal District, maternal mortality, Siberian Federal District

Download Full-text