جستجوی مقالات مرتبط با کلیدواژه « maternal mortality » در نشریات گروه « پزشکی »

 Maternal mortality is one of the most important health issues worldwide. Therefore, the current study aimed to determine the causes of maternal mortality in West Azarbaijan-Iran province during 2013-2020.

 In this retrospective cross-sectional study, demographic data and information on maternal deaths (based on the Pregnancy Mortality Surveillance System) were obtained from the treatment deputy of Urmia University of Medical Sciences. The data were collected and analyzed in the West Azarbaijan-Iran province during the 2013-2020 years.

 Over seven years, 102 maternal deaths occurred. The frequency of direct, indirect, and unknown causes of maternal mortality was 35.28%, 60.8%, and 3.92% respectively. Among direct causes, the leading cause of maternal mortality was hemorrhage (23.52%) and sepsis was the next order (7.84%). In indirect causes, brain diseases had the highest frequency (18.9%). Gestational age, place, and technique of delivery were highly related to the death causes (p<0.05). The mother's age (OR: 1.14, 95% CI: 0.51-2.52), being rural (OR:1.34, 95% CI: 0.57-3.15), and having a history of diseases (OR:1.31, 95% CI: 0.59-2.89) were positively associated with the risk of infant’s mortality. While the gestational age (>37w) (OR:0.047, 95% CI: 0.013-0.18, P<0.001) and high education level (OR: 0.64, 95% CI: 0.27-1.57, P=0.33) were inversely correlated with an increased risk of infant mortality.

Direct and indirect causes of hemorrhage were the most common cause of maternal death.  Gestational age, delivery place, and technique of delivery were significantly associated with the type of death causes.

 Limited data is available on the full spectrum of maternal COVID-19 infection in terms of pregnancy outcomes. The present study aimed to compare the maternal and neonatal outcomes of COVID-19 in infected and non-infected pregnant women.

 A dual-site retrospective cohort study was conducted in two tertiary hospitals in Isfahan, Iran. The sample included 104 infected and 210 non-infected hospitalized pregnant women. Odds ratios (OR) were estimated using multivariate logistic regression.

 There were significant differences between COVID-19-infected and non-infected pregnant women regarding preterm labor (PTL) (odds ratio [OR]: 11.34, 95% confidence interval [CI]: 1.19–48.54, P=0.035); hospitalization days (OR: 7.21, 95% CI: 4.05–12.85, P≤0.001); cesarean section (CS) (OR: 4.76, 95% CI: 1.78–12.45, P=0.002); neonatal admission to neonatal intensive care unit (NICU) (OR: 1.28, 95% CI: 1.12–1.67, P=0.004); and neonatal respiratory distress (OR: 2.37, 95% CI: 1.02– 5.47, P=0.044). No significant association was found between COVID-19 infection and abortion (OR: 0.06, 95% CI: 0.01–1.45, P=0.084); stillbirth (OR: 1.84, 95% CI: 0.05–39.68, P=0.743); Apgar score (1 minute) (OR: 0.91, 95% CI: 0.74–1.13, P=0.382); Apgar score (5 minutes) (OR: 0.97, 95% CI: 0.81–1.18, P=0.765); and low birth weight (LBW) (OR: 4.76, 95% CI: 1.78–12.45, P=0.002).

 PTL, CS, neonatal admission in NICU, neonatal respiratory distress, and hospitalization days were significantly higher in pregnant women with COVID-19 compared to those without infection.

The investigation of Maternal Near‑Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran.

A prospective case‑control study was conducted on 250 women referred to the maternity ward of Nohom‑e‑Dey hospital in Torbat‑e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near‑miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported.

A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant.

Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

 Delayed or avoided medical care due to coronavirus disease 2019 (COVID-19) related concerns may increase morbidity and mortality associated with both acute and chronic health conditions. Thymoma is uncommon in pregnancy, although it could be accompanied with unfavorable outcomes. We report a puerperal woman presented with dyspnea and cardiac arrest with a recent diagnosis of thymoma that led to maternal mortality.

 A 38-year-old woman with occasional dyspnea during pregnancy without medical referral was admitted to the hospital with severe dyspnea and orthopnea three days after cesarean section. Spiral computed tomography (CT) angiography showed a 64 × 84-centimeter mass with soft tissue density in the left perivascular that was originated from the anterior mediastinum; in biopsy, thymoma was suggested. She died shortly after due to severe dyspnea and cardiac arrest.

 Prenatal care during COVID-19 pandemic should not be postponed. Indeed, any symptom similar to the physiologic changes in pregnancy needs to be evaluated for optimal clinical management.

Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available.

This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019.

Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6–171.2) to 94.3 (73.4–121.1) per 100000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3–6.8) in Kuwait to 502.9 (375.2–655.3) per 100000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0–6.4) in Kuwait to 269.9 (195.8–368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations.

MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn’t achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.

Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available.

This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019.

Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7–17.3) per 100000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2–26.4) to 76.9 (38.4–114.7) per 100000 live births across provinces. Respective figures for 2019 were 7.1 (5.2–9.3) to 34.0 (25.1–44.7) per 100000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces.

MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions.

Despite Uganda and other sub-Saharan African countries missing their maternal mortality ratio (MMR) targets for Millennium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to ‘3Cs’ (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming. 

We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and 21 national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the ‘three delay model’ combined with a broader literature on ‘policy mixing.’

Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality, by the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues.

The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the ‘three delays’ but also ensure fidelity of policy design to coherence, comprehensiveness and consistency.

This case study includes three pregnant women with COVID-19 diagnosed during pregnancy or delivery between March 28 and May 13, 2020. All cases were confirmed by a positive pharyngeal reverse transcription polymerase chain reaction (RT-PCR) test and one case by computed tomography scan (CT Scan) in addition to the (RT-PCR). Clinical and laboratory information was extracted from hospital records during pregnancy and delivery. The adverse effects during pregnancy and after the birth of the newborn, the possibility of vertical transmission from positive pregnant mothers to the neonates were investigated. Of the three women with COVID-19 infection, one patient was diagnosed two weeks before delivery and two were diagnosed during delivery and hospitalization. No adverse effects including preeclampsia, gestational hypertension, rupture of the amniotic sac during pregnancy and premature delivery were observed but one of the patients suffered from intrauterine fetal death (IUFD). in this study,  adverse pregnancy outcome was not observed in  pregnant women with Covid-19  infection  based on hospital observations. No vertical transmission was observed following vaginal delivery or cesarean section and during pregnancy. As the effect of the virus on different people in society varies according to their individual characteristics, our conclusion in this study on pregnant women is also affected by these individual differences, which requires further studies in this field with more samples.

It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women.

This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis.

From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth).

The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

Placenta Accreta Spectrum (PAS) affects approximately one in a thousand deliveries. Very few studies evaluated PAS risk factors based on their location. In this study, we have investigated the effects of placenta location on placental adhesion-related complications, its risk factors, and outcomes.

We performed a retrospective cohort study of pathology-confirmed cases of PAS from patients with peripartum hysterectomy, at a large educational hospital in Qazvin, Iran, from 2009 to 2019. Placenta location was found by ultrasound reports and intraoperative evaluation. We measured demographic features, basic characteristics, maternal and neonatal outcomes based on placental location including anterior, posterior, and lateral in Placenta Accreta Spectrum. Chi-square, t-test, and one-way ANOVA were used to examine the relation of complications, risk factors, and outcomes in PAS.

A review of 70 cases showed the distribution of placenta location as follows: 57% anterior, 27% posterior, and 16% lateral. The mean gestational age at delivery was 35 (33-39) weeks. In 78.6% (n=55) of the patients, an association with placenta previa and in 94/2% (n=66) of cases a history of cesarean section was found, however, it was not significantly correlated with placenta location (p=0.082). We found that surgery duration was significantly longer in patients with lateral PAS (155±38, vs 129.35±33.8 and 133.15±31.5 for anterior and posterior placenta respectively, p=0.09). Patients with lateral PAS also bled more than the remaining two groups (2836 ml for lateral PAS vs 2002 and 1847 for anterior and posterior placenta respectively, p=0.022). Moreover, women with a history of uterine surgery were more likely to have posterior PAS compared to those with anterior and lateral PAS (p=0.035).

Differences in complications, risk factors, and outcomes of PAS based on placenta location may lead to improved diagnosis and decreased morbidity in women.

Teenage pregnancy has generated much interest in Obstetrics practice due to increasing risk to the baby and the mother. In this regard, this study was done to ascertain its incidence, obstetric risk, and outcomes.

This study reviewed the obstetric data sheets of all teenage pregnancies managed between January 2013 and December 2017 at the Benue State University Teaching Hospital, Makurdi, North -Central, Nigeria.

Teenage deliveries included 43 cases constituting 2.06% of the total 2084 deliveries within the period. The mean age (SD) was 17.88 (±1.77) years. The commonest antenatal complications were malaria (39.5%), anaemia (37.2%), and hypertension in pregnancy (20.9%). The augmentation of labour was done for 16 parturient mothers (37.2%) and 16.3% had the induction of labour. The caesarean section rate was 16.3% and it was mostly related to obstructed labour (47.1%). In addition, episiotomy was done in 11.6% of parturient mothers and 46.5% had perineal tear. There were 37 live births out of which, 6 cases were neonatal admissions and 6 other cases were perinatal deaths. Finally, the perinatal mortality rate among the teenage deliveries was 139.5 per 1000.

The incidence of teenage births was 2.06% with associated obstetric risks and adverse pregnancy outcomes necessitating improved obstetric care during pregnancy and delivery.

Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia.

The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel.

Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance.

The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.

we aimed to carry out an applied methodological tool, using Root-Cause Analysis (RCA), to determine the main causes of maternal mortality in Fars province, south of Iran, in 2014.

This is a case-series study and was conducted based on a careful examination of records and verbal autopsy with the family of the deceased person and their medical care team. Using RCA, quantitative dynamic modeling was done to display the overall impacts of different causes on maternal mortality. Finally, sensitivity analysis was done to determine the magnitude of contribution of each root-cause of maternal mortality.

Totally, all 10 maternal deaths with Maternal Mortality Rate (MMR) of 13.4 per 100.000 births, were recorded in the maternal surveillance system during 2014. The RCA results revealed that the root-causes of maternal mortality were ignorance and negligence (50%), delay in diagnosis (30%), delay in service provision in the first 24 hours after delivery (10%), and undesirable health care (10%). The results of sensitivity analysis in different scenarios revealed that medical negligence had the highest contribution to maternal mortality.

Although maternal surveillance system stated some causes such as hemorrhage to be responsible for maternal deaths, the RCA showed that root-causes such as medical neglects had a fundamental role. Therefore, maternal mortality can be prevented by reforming the health care system and training all service providers, especially for high-risk mothers

Maternal mortality is a major global health challenge and very common in sub‑Saharan Africa and usually occurs due to complications during pregnancy and childbirth. This study aimed to determine the maternal mortality ratio (MMR) in six local government areas (LGAs) of Ondo State using the sisterhood method.

The study was a cross‑sectional descriptive survey of women in the reproductive age group 15–49 years. Data related to maternal mortality were collected in March 2017 using the indirect sisterhood method. A structured questionnaire was used to collect data and was analyzed using IBM‑SPSS version 25.0 software.

The average MMR in the 6 LGAs was 950 per 100,000 live births with a range of 584–1183 per 100,000 live births. Akoko South had the least MMR of 584 per 100,000 live births, Ondo West had 782 per 100,000 live births, Irele had 982 per 100,000 live births, Owo had 782 per 100,000 live births, Akure South had 1386 per 100,000 live births, and Ile‑Oluji had the highest MMR of 1183 per 100,000 live births. The lifetime risk of dying a maternal death ranged from 0.03 to 0.07, with Ile‑Oluji South having the highest risk. The greatest risk of dying a maternal death was found among adolescents and young adults aged 15–39 years with a peak at 20–24 years.

This study found high MMR in Ondo State, with adolescents and young adults aged 15–39 years being at the highest risk. This calls for consistent interventions to minimize maternal deaths in the state and in Nigeria.

Maternal mortality is a crucial indicator of health care provision within a nation, particularly during the periods of instability. This study aimed to assess the maternal mortality ratio in one of the largest hospitals in Baghdad over eight years including the time of the threat of the so-called Islamic State of Syria and Iraq.

A cross-sectional study was undertaken by reviewing the records of mothers who passed away in the hospital from February 2011 to February 2018. The gathered data included the patients’ demographic features as well as obstetrical and medical conditions and causes of death each year.

During the eight years, the total live births numbered 95 800 while 52 mothers died for a maternal mortality ratio of 58.12 per 105 . Most of the deceased mothers aged between 30 and 39 years (P = 0.0015), were multiparous and from rural residence (P = 0.000), booked no antenatal care (P = 0.0014), and completed delivery via a cesarean section (P = 0.0184). The majority died in the postpartum period (P = 0.000) within the first 12 hours of admission (P = 0.000). Finally, the major presentation and cause of death were often obstetrical hemorrhage.

The maternal mortality was high and obstetrical hemorrhage was the main cause of death. In addition, the majority of patients died within the first 12 hours of admission, which is attributed to delays in access to the hospital and the lack of needed facilities during that critical period of time.

In a lower-middle income country, such as Ghana, maternal death still occurs even in case of providing skilled perinatal care. The impact of maternal death on the family, community, and society has been largely studied. However, its implications for midwifery practice in Ghana has not been extensively investigated. The purpose of this study was to explore the experiences of midwives whose clients died during the peripartum period and unearth the influence of their experiences on their personal lives and practices as midwife.

The present study adopted a descriptive exploratory approach. Purposive and snowball sampling were employed to recruit six midwives attending the women who died during the peripartum period. The experiences of midwives were uncovered using in-depth interviews. Data analysis was conducted using Colaizzi’s phenomenological method as a frame of reference. Rigor was maintained through member checking and prolonged engagement.

Four main themes emerged from the data, including conceptualizing maternal death, midwives initial reaction to maternal death, perceived preparedness to manage maternal death, and building resilience (blurring the memory). There was minimal institutional support for the midwives when maternal death occurred. The participants used various coping strategies to rebuild their self-confidence and professional confidence.

Midwives attending women who die during the peripartum period suffer emotionally and psychologically. The implications of these experiences in the midwifery profession are enormous. Supportive strategies should be institutionalized to achieve the complete recovery of attending midwives and provide experiential training of the entire midwifery staff.

Birth-preparedness and complication readiness (BPCR) is an evidence-based strategy for reducing maternal and neonatal mortality. This study aimed to assess the knowledge and practice regarding BPCR and the associated factors among rural women in south Karnataka. In this cross-sectional study, 100 mothers who had delivered in the previous year were randomly selected from 17 villages near Bangalore, south India and interviewed using the JHPIEGO BPCR Tools and Indicators for Maternal and Newborn Health from 2016 to 2017. The association between various exposure variables and knowledge and practice of BPCR was investigated with Chi-square test and Fischer’s exact test; a P value of The proportion of women with adequate knowledge and practice of BPCR was 8% and 38%, respectively. All women identified a health facility for delivery, 73% arranged advance emergency transport, 50% saved money; however, only 4% identified a potential blood donor in spite of 88% being aware of their blood group. Though severe bleeding was a commonly stated danger sign, prior arrangement for blood was not practiced. This issue is of public health importance as haemorrhage continues to be one of the leading causes of maternal mortality. The knowledge and practice of BPCR among rural women who had delivered in the previous year were low. Knowledge and practice of BPCR were associated with higher maternal education and higher socio-economic status. It is recommended that pregnant women and their families receive information regarding BPCR during routine antenatal visits and during home visits from village level workers.