Global causes of maternal death: a WHO systematic analysis

Say, Lale; Chou, Doris; Gemmill, Alison; Tunçalp, Özge; Moller, Ann Beth; Daniels, Jane; Gülmezoglu, A Metin; Temmerman, Marleen; Alkema, Leontine

doi:10.1016/s2214-109x(14)70227-x

Cited by 4,929 publications

(4,138 citation statements)

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“…Hypertension in pregnancy is the second leading global cause for maternal death following hemorrhage, accounting for 14% of all maternal deaths worldwide 1. Prevention and management of hypertension in pregnancy is a critical clinical initiative, as pregnant women presenting with hypertension can rapidly deteriorate into a life‐threatening hypertensive crisis that potentially requires hospitalization, intense monitoring, and iatrogenic preterm delivery to stabilize the maternal condition.…”

Section: Introductionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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BackgroundHypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy.Methods and ResultsTwenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy.ConclusionsConsolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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“…Maternal mortality is a global major public health problem [2]. Worldwide, haemorrhage is the leading direct cause of maternal death, followed by hypertension or pre-eclampsia, sepsis, abortion and embolism [3]. Adequate healthcare, provided by clinically trained and certified healthcare professionals such as midwives, obstetric nurses or physicians before, during and after childbirth, has been identified as the single most important factor in saving the lives of pregnant women and newborns [4].…”

Section: Introductionmentioning

confidence: 99%

Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives’ experiences and views of obstetric ultrasound

Holmlund

Ntaganira

Edvardsson

et al. 2017

Global Health Action

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Background: Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed. Objectives: To explore Rwandan midwives’ experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects. Methods: A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS). Results: Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed. Conclusions: Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda. RESPONSIBLE EDITOR Virgilio Mariano Salazar Torres, Karolinska Institute, Sweden

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“…Within this critical period, quality of care improvement efforts would target essential maternal and newborn care and additional care for management of complications that could achieve the highest impact on maternal, fetal and newborn survival and well‐being. Based on the current evidence on burden and impact, the following specific thematic areas have been identified as high priority for this vision:10, 11, 12 …”

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confidence: 99%