Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean

Duley, Lelia

doi:10.1111/j.1471-0528.1992.tb13818.x

Cited by 496 publications

(331 citation statements)

References 17 publications

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“…According to WHO estimation, eclampsia is the cause of 12 % of all maternal death globally [1]. Eclampsia probably accounts for 50,000 maternal deaths a year worldwide [2]. In India, reported incidence of eclampsia varies from 0.179 to 3.7 % [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Eclampsia in India Through the Decades

Nobis¹,

Hajong²

2016

J Obstet Gynecol India

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Background Eclampsia is still prevalent in India with high maternal and perinatal mortality. In India, there is no community-based survey of eclampsia. Sporadic reports of study on eclampsia are being published in medical journals.Objectives The objective of this study was to find out the incidence of eclampsia and maternal and perinatal mortality in India. Methods Data on incidence, maternal mortality and perinatal mortality of eclampsia were collected from articles published in journals and from book of Abstract published during AICOG conferences from 1980 onwards, along with our own data from 1976 to 2014. Data were analyzed yearwise. Results Reports published from 1976 to 2015 (JanuaryFebruary) reveal that incidence of eclampsia in India ranges from 0.179 to 5 %, the average being 1.5 %. In the period between 1980 and 1989, the average incidence was 0.92 % and the corresponding figure between 2002 and 2010 was 2.15 %, indicating that there is no reduction in Dr. P. N. Nobis Retired as Professor and Head of the Department of Obstetrics and Gynecology from Silchar MedicalCollege is now working at International Hospital at Dispur, Guwahati, as Senior Consultant. He has about ten publications in National Journals including six in this journal. He has authored three textbooks of Obstetric and Gynaecology of which one is in vernacular. He has special interest in hypertensive disorders of pregnancy and pediatric gynecology.The Journal of Obstetrics and Gynecology of India (September-October 2016) 66(S1):S172-S176 DOI 10.1007/s13224-015-0807-5123 incidence of eclampsia in India over the decades. Maternal mortality in 1982 was 14.12 %, and in 2010 it was 2.2-9 %. Maternal mortality has shown a receding tendency, while perinatal mortality is remaining still high as in 1984 it was 45 % and the corresponding figure in 2010 was 24.5-48 %. Conclusion Incidence of eclampsia in India is about 1.5 %. Detail analysis of data from 1980 to 2015 (JanuaryFebruary) shows that there is no reduction in incidence of eclampsia and perinatal mortality rate over the last few decades. Maternal mortality has shown a slight receding trend.

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Section: Introductionmentioning

confidence: 99%

Eclampsia in India Through the Decades

Nobis¹,

Hajong²

2016

J Obstet Gynecol India

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“…1,2 The early diagnosis of pre-eclampsia and of pre-eclampsia complicated by intrauterine growth restriction (IUGR) remains one of the important aims of antenatal care. Nevertheless, despite the many potential screening tests available, none has been shown to be of clinical significance.…”

Section: Introductionmentioning

confidence: 99%

White coat hypertension and pregnancy outcome

et al. 1999

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The presence and outcome effect of white coat hypertension in pregnancy was determined with 24-h ambulatory blood pressure (BP) monitoring. Sixty women presenting with high clinic BP (у140/90 mm Hg) in the second trimester were included. Patients were divided into two groups based on daytime ambulatory BP findings: Ͻ135/85 mm Hg, white coat hypertension (n = 37); у135/85 mm Hg, 'true' hypertension (n = 23). Complicated pregnancy outcome was defined as the presence of pre-eclampsia and/or intrauterine growth restriction. Groups were compared for pregnancy outcome and for background and delivery factors. The predictive value of ambulatory BP measurements for pregnancy outcome was determined.

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“…[169][170][171][172] Studies from different parts of the world, including the UK, show a higher risk of mortality among women who do not receive adequate antenatal care. 156,169,171,173 Although there is a debate about the role of antenatal care in preventing maternal deaths caused by acute conditions that emerge close to the time of delivery, its role in identifying pregnant women at high risk (such as women with hypertensive disorders, medical comorbidities, anaemia and infections) and lowering their risk of mortality is widely accepted.…”

Section: Conclusion and Implications For Policy And Practicementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean

Cited by 496 publications

References 17 publications

Eclampsia in India Through the Decades

Eclampsia in India Through the Decades

White coat hypertension and pregnancy outcome

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

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