Changing epidemiology of maternal mortality in rural India: time to reset strategies for <scp>MDG</scp>‐5

Shah, Pankaj; Shah, Shobha; Kutty, Raman; Modi, Dhiren

doi:10.1111/tmi.12282

Cited by 29 publications

(30 citation statements)

References 10 publications

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“…In rural areas with presumably less availability and/or access (transport) to care, more women die at home, which is similar to the findings of studies conducted in India, Tanzania and Zimbabwe . However, a recent study from Gujarat, India also reported that the majority of maternal deaths now occur in hospital …”

Section: Discussionsupporting

confidence: 80%

Cause of and contributing factors to maternal deaths; a cross‐sectional study using verbal autopsy in four districts in Bangladesh

Halim¹,

Utz

Biswas³

et al. 2014

BJOG

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Verbal autopsy used at community level is an accepted method to identify cause of death and factors contributing to death. Maternal deaths occurring in four districts in Bangladesh over a period of 24 months were identified and community health workers were trained to conduct a verbal autopsy. Of 571 maternal deaths identified almost half (273, 47.8%) occurred at facility level, 97 (17.0%) died en route to a healthcare facility and 201 (35.2%) maternal deaths occurred at home. The majority of maternal deaths occurred in the postpartum period (78.8%) in the first 6 hours after giving birth (41.6% of all postpartum deaths). Women who had accessed care at a healthcare facility were less likely to die in the first 6 hours when compared with women who died at home (relative risk 0.70; 95% confidence interval 0.56-0.88) 70.4% (402) of deaths were classified as direct maternal deaths, 12.4% (71) as indirect and 13.8% (79) as unspecified. The most common cause of death was haemorrhage (38%), followed by eclampsia (20%) and sepsis (8.1%). Almost three out of four women who died had sought care for complications during the index pregnancy. Most mothers who died in Bangladesh had accessed care. It is now crucial that the quality of care received at health facility level is improved. This includes a refocus on strengthening healthcare providers' knowledge and skills to recognise and manage complications and provide emergency obstetric care. The enabling environment must be in place as well as ensuring a fully functional referral pathway between healthcare facilities.

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Section: Discussionsupporting

confidence: 80%

Cause of and contributing factors to maternal deaths; a cross‐sectional study using verbal autopsy in four districts in Bangladesh

Halim¹,

Utz

Biswas³

et al. 2014

BJOG

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“…EP accounts for 3.5-7.1% of maternal mortality in India. 17,18 Maternal mortality in present study is 3.27%. More cases were seen between age group 21-30 years (54.8%) in present study which is similar to other studies conducted by Tuli AG et al, Spandana N et al 19,20 The most important cause of ectopic pregnancy is damage to the tubal mucosa may be due to infections, which could obstruct embryo transport due to scarring.…”

Section: Discussionmentioning

confidence: 46%

A clinical study of ectopic pregnancy in a tertiary care hospital

Behera¹,

Ghadei²,

Bal³

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Ectopic pregnancy is a life-threatening emergency commonly encountered by medical practitioner. Diagnosis is frequently missed and should be considered in any women in the reproductive age group with abdominal pain or vaginal bleeding. The aim of the study is to assess the incidence, clinical presentation, risk factors, methods of diagnosis, treatment, outcome and complications.Methods: This was a prospective study at S.C.B. Medical college from January to December 2017. Parameters like age, parity, gestational period, risk factors, clinical presentations, findings on ultrasonogram and at surgery with morbidities associated with diagnosed cases of ectopic pregnancy (n=93) were noted and analysed with SPSS-19 software.Results: Incidence of ectopic pregnancy was 18/1000 deliveries. Maximum cases were in age group of 21 to 30 years (54.8 %) and parous (76.3%). Common risk factors were having history of abortions (46.2%), previous tubal sterilization (24.7%), having one or more caesarean section (17.2%) and h/o infertility (16.1%). Most common symptom was pain abdomen (96.8%). Commonest site was ampullo-isthmic region of tube and rupture was the commonest mode of presentation. All underwent laparotomy and unilateral salpingectomy was done in 86 % of cases. It contributed to 3.27 % of total maternal deaths.Conclusions: Suspicion in high risk group can direct one to investigate and diagnose early, thereby reducing morbidity, mortality and improving the prospect of future fertility.

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“…It accounts for 3.5-7.1% of maternal mortality in India. 11,12 In India the incidence of ectopic pregnancy reported by the Indian council of medical research (ICMR 1990) task force in their multi-centric case control study was 3.12 per 1000 pregnancies or 3.86 per 1000 live births in the hospital reported pregnancies. In present study the incidence is significantly higher at 3%, than most of the other studies in developing countries, where it ranges from 0.56-1.5%.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of ectopic pregnancy at a tertiary care centre

Mehta¹,

Jamal²,

Goel³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The aim of this study was to determine the incidence, clinical presentation, risk factors, treatment, and morbidity and mortality associated with ectopic pregnancy.Methods: The present retrospective study was conducted over a period of three years in the department of obstetrics and gynecology at SMS and R, Greater Noida, UP from Feb 2014 to Jan 2017.A total of 80 patients with ectopic pregnancy were analyzed regarding clinical presentation, risk factors, operative findings and treatment modality.Results: Total number of 80 cases of ectopic pregnancies were admitted during this period against 2645 deliveries representing frequency of 3%. Majority of cases (43.75%) were in the age group of 25-29 years and 41.25% were gravida 4 and above. Risk factors were identifiable in 66.25% of cases. Previous abortion was the most common risk factor (31.25%). The classical triad of amenorrhea, pain abdomen and vaginal bleeding was present in 71.25% of cases. More than half of case (55%) had ruptured tubal pregnancy on admission. Unruptured tubal pregnancy was seen in 10% case. Interestingly we found one rare case of bilateral ectopic pregnancy. Salpingectomy by open method was the mainstay of treatment (86.25%).Conclusions: Ectopic pregnancy is still a major challenge in gynecological practice. In our country most of the cases present late after tubal rupture requiring radical surgical treatment. Early diagnosis and timely intervention in the form of medical treatment or conservative surgery not only reduces maternal morbidity but also preserves future fertility.

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Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

Cited by 29 publications

References 10 publications

Cause of and contributing factors to maternal deaths; a cross‐sectional study using verbal autopsy in four districts in Bangladesh

Cause of and contributing factors to maternal deaths; a cross‐sectional study using verbal autopsy in four districts in Bangladesh

A clinical study of ectopic pregnancy in a tertiary care hospital

A retrospective study of ectopic pregnancy at a tertiary care centre

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