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Multicenter Study
. 2020 Aug;127(9):1082-1089.
doi: 10.1111/1471-0528.16309. Epub 2020 Jun 2.

Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial

N Vousden  1 , E Holmes  1 , P T Seed  1 , M F Gidiri  2 , S Goudar  3 , J Sandall  1 , S Chinkoyo  4 , L Y Kumsa  5   6 , A Brown  5   6 , U Charantimath  3 , M Bellad  3 , A Nakimuli  7 , B Vwalika  8 , L C Chappell  1 , A H Shennan  1 ; CRADLE Trial Collaborative Group
Collaborators, Affiliations
Multicenter Study

Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial

N Vousden et al. BJOG. 2020 Aug.

Abstract

Objective: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources.

Design: This is a secondary analysis of a stepped-wedge cluster randomised controlled trial.

Setting: This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti.

Population: Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion.

Methods: Pregnancy-related deaths were collected prospectively from routine data sources and active case searching.

Main outcome measures: Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome.

Results: Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death.

Conclusions: The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists.

Tweetable abstract: Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.

Keywords: Epidemiology; low and middle resource; maternal mortality.

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References

    1. World Health Organisation U, UNFPA, World Bank Group and the United Nations Population Division. Maternal Mortality: Levels and Trends 2000 to 2017. Geneva: World Health Organisation; 2019.
    1. World Health Organisation. Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: World Health Organisation; 2007 [www.who.int/whosis/mme_2005.pdf]. Accessed 20 November 2017.
    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323-33.
    1. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet 2006;368:1189-200.
    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study. Lancet 2013;384:980-1004.

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