Maternal mortality: only 42 days?

Høj, Lars; Silva, Domingos da; Hedegaard, Kathryn; Sandström, Anita; Aaby, Péter

doi:10.1016/s1470-0328(03)03907-7

Cited by 31 publications

(22 citation statements)

References 23 publications

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“…This change in definition is important since there is evidence that risk of death is increased for up to 6 months postpartum. 2 In our study there were 10 cases of late maternal deaths, the longest case died 116 days after delivery due to brain stem hemorrhage resulted from eclamptic fits.…”

Section: Discussionmentioning

confidence: 59%

“…1 The 42-day limit is somewhat arbitrary, and in recognizing the fact that modern life-sustaining procedures and technologies can delay death, ICD-10 introduced a new category, namely the late maternal death, which is defined as the death of a woman out of direct or indirect obstetric causes more than 42 days but less than one year after the termination of pregnancy. 2 Maternal mortality ratio is defined as the number of women who died while pregnant or within 42 days of termination of pregnancy per 100,000 live births. 3 Maternal deaths are divided into two groups.…”

Section: Introductionmentioning

confidence: 99%

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Maternal mortality: a tertiary care hospital experience in Upper Egypt

Abbas

Amin

Ali

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Maternal mortality: a tertiary care hospital experience in Upper Egypt

Abbas

Amin

Ali

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…Maternal mortality surveillance studies such as confidential enquiry have showed that late maternal death is non-trivial in even low-resource settings34,59 and can account for up to 40% of maternal deaths in high-income settings 60. A contemporary linkage study in Mexico found that 18% of maternal deaths are missed when the definition is truncated at 42 days’ post partum 61.…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Kassebaum¹,

Barber²,

Bhutta³

et al. 2016

The Lancet

841

469

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Summary Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum r...

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“…30 Consequently, the contribution of pregnancy-related deaths to mortality among women of reproductive age is likely to be underestimated. Indeed, extending the definition to include all deaths within 3 months of delivery increases current estimates of maternal mortality in low-income settings by 10% to 15%.…”

Section: Researchmentioning

confidence: 99%

“…Indeed, extending the definition to include all deaths within 3 months of delivery increases current estimates of maternal mortality in low-income settings by 10% to 15%. [30][31][32] Incorporating late maternal deaths within 1 year of the end of pregnancy would further increase the figure.…”

Section: Researchmentioning

confidence: 99%