The etiology of maternal mortality in developed countries: a systematic review of literature

Rossi, A. Cristina; Mullin, Patrick

doi:10.1007/s00404-012-2301-y

Cited by 49 publications

(27 citation statements)

References 20 publications

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“…A hospital‐based review of maternal mortality in Ghana of 30 269 live births and 322 MDs indicated that 22.4% were from indirect causes, and that infection and sickle cell disease accounted for 61.1% of indirect causes . A systematic review of 12 articles from developed countries between 1980 and 2007 with 9750 MDs showed that 28.6% were from indirect causes, with cardiovascular disease as the main cause . A community‐based study from Sudan using a reproductive age mortality survey (RAMOS) showed that 29.7% of MDs were from indirect causes, with severe anaemia and acute febrile illness as the two leading causes .…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports indicated that indirect causes were responsible for about a quarter of all maternal deaths . The main indirect causes included anaemia, cardiac disease, HIV/AIDS, and cerebrovascular disease . In 2009, WHO, through an international consultative process, developed a standard definition of maternal near miss, using markers of organ dysfunction during pregnancy, childbirth, or after birth .…”

Section: Introductionmentioning

confidence: 99%

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Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Lumbiganon

Laopaiboon

Intarut

et al. 2014

BJOG

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Objective To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes.Design Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.Setting A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East.Sample A total of 314 623 pregnant women admitted to the participating facilities.Methods We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities.Main outcome measures Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission.Results Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/ 2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1).Conclusions Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Lumbiganon

Laopaiboon

Intarut

et al. 2014

BJOG

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“…Excessive bleeding (named as ‘serakian’) was the common problem mentioned. Many studies reveal that hemorrhage is the most common type of obstetric complication and that it is the top direct obstetric cause of maternal death [1], [22]. According to further interviews of mothers and families experiencing complications, bleeding is associated with evil spirits.…”

Section: Discussionmentioning

confidence: 99%

Maternal Complications and Women's Behavior in Seeking Care from Skilled Providers in North Gondar, Ethiopia

2013

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BackgroundMaternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study.MethodsThis study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders.ResultsOut of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider.ConclusionNearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care.

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“…Thromboembolic events are one of the leading causes of maternal death during the postpartum period. The maternal death rate due to thromboembolic events in developed countries is reported to be 1.34 per 100 000 live births, comprising 14.9% of all maternal deaths in developed countries . Anticoagulation therapy is used widely during pregnancy and the postpartum period; however, thrombolytic therapy with recombinant tissue plasminogen activator (rt‐PA) is controversial because the treatment may lead to massive bleeding.…”

Section: Introductionmentioning

confidence: 99%

Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature

Akazawa

Nishida

2017

Acta Obstet Gynecol Scand

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Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery. Blood transfusion was necessary in all cases except for one (12/13; 92%). In seven cases (7/13; 54%), a large amount of blood was required for transfusion. Subsequent laparotomy to control bleeding was required in five cases (5/13; 38%), including three cases of hysterectomy and two cases of hematoma removal, all of which involved cesarean delivery. In cases of transvaginal delivery, there was no report of laparotomy. The occurrence of severe bleeding was high in relation to cesarean section, compared with vaginal deliveries. Using rt-PA in relation to cesarean section might be worth avoiding. However, the paucity of data in the literature makes it difficult to assess the ultimate outcomes and safety of this treatment.

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The etiology of maternal mortality in developed countries: a systematic review of literature

Abstract: Conditions leading to hemorrhage warrant strict management. The risk of an apparently healthy woman to die during motherhood is 0.22 out of 100,000 livebirths.

Cited by 49 publications

References 20 publications

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Maternal Complications and Women's Behavior in Seeking Care from Skilled Providers in North Gondar, Ethiopia

Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature

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