Maternal Mortality: A Retrospective Study

Color lines: Disparities in pharmacy treatment, education, and practice

Background: The global maternal mortality rate (MMR) in 2022 is 91.46 per 100,000 live births with the cause of death being bleeding while the indirect causes of maternal mortality are during pregnancy wheere many pregnant women experience nutritional problems such as Chornic Energi Deficiency ( CHD) and Nutritional Anemia at 8.43% (WHO, 2022). The maternal mortality rate in ASEAN is 235 per 100,000 live births with the majority of causes of death being bleeding (ASEAN Secretariat, 2022). Until now, the maternal mortality rate in Indonesia alone in 2020 was 91.45/100,000 live births. In 2021, maternal mortality will increase to 305/100,000 live births. Meanwhile, in 2022, the maternal mortality rate will decrease by 230/100,000 live births. Within a period of 3 years, the causes of maternal death included Covid 19, bleeding, hypertension in pregnancy, and heart disease (Ministry of Health of the Republic of Indonesia, 2022). The maternal mortality rate in Central Java in 2020 was 84.6/100,000 live births, in 2021 it will be 199/100,000 live births. In 2022 there will be a decrease to 98.6/100,000 live births, hypertension in pregnancy and bleeding are still the cases of death in that year (Central Health Office, 2022). Brebes Regency shows that the maternal mortality rate in 2020 was 62 cases. In 2021 there were 105 cases and in 2022 there was a decrease to 50 cases with the causes of death being bleeding, hypertension, infection and heart disorders (Brebes District Health Office, 2021) Objective: Reduce maternal and infant morbidity and mortality rates in Brebes Regency, especially the Bumiayu Community Health Center area Conclusion: After providing comprehensive midwifery care to Mrs. S aged 32 years with Chronic Energy Deficiency (KEK) at BPM Mrs. The R working area of the Bumiayu Community Health Center from the third trimester of pregnancy, childbirth, newborns, postpartum and family planning is in good condition.

BackgroundDespite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria.MethodsA retrospective observational study was performed in a 41-bed obstetric ward. From October 2010 to May 2011, demographic data, obstetric characteristics, and outcome were collected from all pregnant women admitted. The total number of live births during the study period was recorded in order to calculate the maternal mortality ratio.ResultsThere were 2,177 deliveries and 39 maternal deaths during the study period, with a maternal mortality ratio of 1,791/100,000 live births. The most common causes of maternal mortality were hemorrhage (26%), puerperal sepsis (19%), and obstructed labor (5%). No significant difference (P = 0.07) in mean time to reach the hospital was noted between fatal cases (1.9 hours, 95% confidence interval [CI] 1.1–2.6) and nonfatal cases (1.4 hours, 95% CI 1.4–1.5). Two hundred and sixty-six women were admitted presenting with stillbirth. Maternal mortality was higher for unbooked patients than for booked patients (odds ratio 5.1, 95% CI 3.5–6.2, P < 0.0001). The neonatal mortality rate was calculated at 46/1,000 live births. The main primary causes of neonatal deaths were prematurity (44%) and birth asphyxia (22%).ConclusionMaternal and neonatal mortality remains unacceptably high in this setting. Reducing unbooked emergencies should be a priority with continuous programs including orthodox practices in order to meet the fifth Millennium Development Goal.

This report of the Dutch Maternal Mortality Committee analyzes maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in maternal mortality. The findings were compared with those of an initial report covering the years 1983–1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was maternal mortality expressed as the maternal mortality ratio (MMR), which is defined as the number of direct and indirect maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. Obstetric Complications (Maternal Mortality) A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983–1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of maternal mortality, accounting for 39.4% of all direct maternal deaths. Other direct causes of maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983–1992, but the differences were not statistically significant. Compared to 1983–1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4–4.6). The highest risks for maternal death were found in teenagers (<20 years of age), women aged 45 years and above, and women in the immigrant population. Most substandard care during the study period occurred among women with preeclampsia (91%) and in immigrant populations (62%). These findings show an alarming increase in MMR in the Netherlands during the years 1993–2005 compared to the 1983–1992 period. As in the earlier study period, preeclampsia is the leading cause of maternal mortality. Substandard care is a major concern. The investigators recommend that health professionals and women at increased risk for preeclampsia and other complications during pregnancy should be educated about the danger signs for such complications. In addition, professionals require better training to manage these complications and prevent them when possible.

Objectives:The primary objective of this study is to study Maternal Mortality as per Gravidity among Tribal women at a tertiary level of care in Bastar, Chhattisgarh, India.Materials and Methods:This is a hospital based, retrospective, reproductive-age mortality study (RAMOS) of tribal women of Bastar region, Chhattisgarh, that were admitted and managed in Obstetrics and Gynecology Department Govt. Medical College, Jagdalpur, Bastar, Chhattisgarh, between July 2007 and October 2011. There were total 120 cases.Result:Results of the present study showed that among 120 deceased tribal women highest maternal mortality 65 cases (54.166%) was noted in Primigravida (Nullipara G1P0), second highest maternal mortality 44 cases (38.333%) was noted in 2nd to 4th Gravida (Multipara), 10 cases (8.333%) were in 6th and 7th Grand Multigravida (Grand Multipara), and 01 case (0.833%) was in 8th Great Grand Multigravida. Direct causes of maternal mortality were highest 46 cases (38.333%) due to hypertensive disorders of pregnancy. Among direct causes second highest 18 cases (14.999%) maternal mortality were due to Rupture Uterus, third highest 12 cases (09.999%) of Septicemia, 06 cases (04.999%) of obstructed labor, 06 (04.999%) of Hemorrhage, 02 cases (01.666%) of unsafe Abortion, 02 cases (01.666%) of Pulmonary Embolism and 01 case (0.833%) due to Aspiration. Indirect causes of maternal mortality maximum 15 cases (12.5%) of Malaria and 10 cases (08.333%) were due to Anemia and 02 cases (01.666%) were of Sickle cell Anemia. The result of the present study showed that in tertiary level of care of Bastar in the year 2007 – 2008, 2008 - 2009, 2009 – 2010 and 2010 - 2011 the total maternal deaths were 34 (n=34); 35 (n=35); 27 (n=27) and 26 (n=26) respectively. The Maternal Mortality Ratio was 1611.876; 1615.881; 1168.325 and 1000.769 Per 1, 00,000 live births in the year 2007- 2008; 2008 - 2009; 2009 – 2010 and 2010 - 2011 respectively. In the year 2007 - 2008, maternal mortality percentage among tribal women was 80.314%; in the year 2008-2009 was 85.714% and was 100% in the year 2009 – 2010 and 2010 – 2011.Conclusion:Discusses and/or relates this study’s results to the need for improvement in the maternal health of tribal women of Bastar. It has been discussed well in the conclusion section.

TEMPORARY REMOVAL: Mortalité maternelle en France, 2016–2018, fréquence, causes et profil des femmes

Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions.

BackgroundCurrent estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya.MethodsWe used data from verbal autopsy interviews conducted on nearly all female deaths aged 15–49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004–2005 to examine causes of maternal death.ResultsThe maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia.ConclusionMaternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal deaths.

Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic.&#x0D; Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21.&#x0D; Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality.&#x0D; Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.&#x0D;

Despite global progress and a marked reduction in maternal mortality ratio worldwide, the burden of maternal death and morbidity remains a huge challenge, especially among low- and middle-income settings. Maternal mortality is determined by multiple components. As a result, sustainable strategies require not only the implementation of effective health policies but also social development. In this narrative review, we discuss strategies to improve the maternal mortality ratio based on recent advances in public health. Primary care plays a key role in identifying background conditions, risk factors and early signs of some major causes of maternal mortality and morbidity. Antenatal care also addresses other conditions that influence outcomes: unwanted pregnancies, nutrition, sexually transmitted illnesses, family planning, immunization, and child health. Therefore, awareness about major causes of maternal mortality, direct and indirect targeted interventions to adequately identify risk factors, implement prophylactic interventions when available and guarantee early diagnosis, can certainly impact outcomes.

Trends in maternal mortality in Suriname: 3 confidential enquiries in 3 decades

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation. Impact Statement What is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem.

One of the key measures of a nation’s overall health and well-being is the incidence of maternal mortality (Osunu, Ofili, and Nwose, 2021). The Maternal Mortality Ratio (MMR), which is estimated as a ratio per 100,000 live births in the survey population, is frequently used to quantify maternal mortality (WHO, 2019). According to statistics, 287,000 maternal fatalities were recorded worldwide in 2020, with sub-Saharan Africa having the greatest casualty count and Eastern Asia holding the least (Mhyre, 2020). According to the aforementioned statistic, there are 223 maternal deaths for every 100,000 live births, which translates to a 1 in 210-lifetime probability risk for any girl of reproductive age to die from pregnancy-related causes (Mhyre, 2020). This article addresses maternal mortality as a global health issue. It provides an in-depth overview of its epidemiology, stating prevalence rates based on global, regional, and local estimates. Postpartum bleeding, hypertensive problems in women, obstructed labor, unsafe abortions, and obstetric sepsis are some of the leading direct causes of maternal mortality (Von-Dadelszen and Magee, 2017). It also highlights risk factors such as HIV/AIDS, age, and social determinants like education, as well as their impacts on the general population. This article also examines the global and national policy initiatives that are in place to tackle the prevalence of maternal mortality around the world, the majority of which are a continuation of the promises to improve global health from the 2015 Millennium Development Goals (MDGs) into the current Sustainable Development Goals (SDGs) that will remain in effect until 2030. The overall goal is to reduce the global MMR to fewer than 70 per 100,000 live births by 2030 (WHO, 2015). Evidence suggests that these policies are effective in some areas and lead to a slight decrease, but the effectiveness of some global policies has been constrained by their lack of coordination and their inherent contradictions. The assignment examines different health interventions and describes the concept of the health promotion model that adopts these concepts as regards trying to reduce maternal mortality, especially in sub-Saharan Africa. In conclusion, the articled highlights some of the challenges faced in the execution of these responses and makes recommendations for activities that will assist in addressing the national and international regulations that have prevented significant advancements in the decrease in maternal mortality.

BackgroundIn 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.ObjectiveTo evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.MethodsDesign: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.ResultsOver the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.ConclusionsThis safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

To study the causes of maternal mortality in two consecutive five year periods over a decade (1997-2001/2002-2006) in a university hospital. A maternal mortality over 10 years (1997-2006) was analyzed prospectively from the Obstetrics/Gynecology Department of Tribhuvan University Teaching Hospital. The maternal mortality ratio of 267.5/100 000 live births was affected by 83 (41 [49.3%] direct, 36 [43.3%] indirect and six [7.2%] non-obstetric) maternal deaths in 31,021 live births. Direct cause was led by infections (n=23, 27.7%): 15 septic abortions (two [2.4%] spontaneous and 13 [15.6%] induced; seven of these occurred in 1997-2001); along with seven (8.6%) cases of puerperal sepsis; a case of antenatal septic shock; and a case of hemolysis, elevated liver enzyme levels, and low platelet count syndrome. There were eight (9.8%) cases of obstetric hemorrhage (six post-partum hemorrhage; two abortions); eclampsia (n=2); severe pregnancy-induced hypertension with hemolysis, elevated liver enzyme levels, and low platelet count syndrome (n=1); and cesarean complications included one from anesthesia and another surgical, which was included under post-partum hemorrhage. There were two cases of pulmonary embolism and four unexplainable deaths. Indirect causes included infective hepatitis (n=19, 22.8%) (13 of these occurred in the more recent 5-year period [2002-2006]), followed by heart disease (n=6), tuberculosis (n=5, 6%), anemia (n=3, 3.6%) and a case each of meningitis, chronic renal failure and diarrhea. Six non-obstetric deaths occurred: one from a road traffic accident; and five due to suicidal (n=1) and accidental (n=4) burns. Maternal mortality over a period of a decade in an institutional setting exhibited induced septic abortion as the main cause of maternal death during the first five years of the study period (1997-2001). In the second five years of the study period (2002-2006) an alarming rise in infective hepatitis became the main cause of maternal death.