Maternal deaths due to indirect causes: Report from a tertiary care center of a developing country

Hossain, Nazli; Shaikh, Zeenat Fareed

doi:10.1177/1753495x211037916

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Cardiac disease in pregnancy is emerging as an important indirect cause of maternal death. 18 Intracranial haemorrhage in hypertensive disorders of pregnancy is a major cause of maternal death 19 . Hepatic encephalopathy due to hepatitis E virus, is an important cause of maternal death in developing world.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Khan¹,

Jamil²,

Butt³

et al. 2023

PJMHS

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Aim: To describe characteristics, etiological factors, maternal and perinatal outcome of perimortem Caesarean section. Design: Prospective study Setting: Emergency Room of Department of Obstetrics & Gynecology Unit IDr.Ruth KM Pfau Civil Hospital & Dow Medical College, Karachi. Methodology: This study was carried out in the Department of Obstetrics and Gynaecology, Civil Hospital Karachi from November 2020 to March 2021. All women who were presented in emergency in a collapsed state were included in the study and those women who were brought dead were excluded. Clinical details including age, gestational age, reason for perimortem Caesarean section, perinatal and maternal outcome were recorded on a predesigned proforma. Results: A total of 27 women underwent perimortem Cesarean section. The mean age of women who underwent PMCS was 266.5 years, and mean gestational age was 35±4weeks. Sixteen (59%) women were referred from either primary care or small clinics. Majority 15(55%), underwent PMCS within 5 minutes of maternal collapse and 12(44%) underwent PMCS, after 5 minutes of collapse. Septic shock 21(77%) was the main etiological factor for PMCS, followed by hypertension and cardiomyopathy 2(7%) each. Twenty three (85%) women survived, following PMCS, whereas 4(14%) died. Reasons for maternal death included hepatic encephalopathy(1), peripartum cardiomyopathy(2), eclampsia(1). The perinatal mortality was high, with only 14(51%) live birth and mean APGAR score at 1 and 5 minutes was 3. The mean stay in intensive care was 37 35 hours, whereas mean stay in ward was 5739 hours. Practical implications: This study suggests that if perimortem caesarean section accomplished in a timely manner, it can improve fetomaternal outcome. Conclusion: Perimortem Caesarean section can improve upon maternal survival. Greater awareness among doctors, multidisciplinary approach, proper documentation and information for family members are cornerstone of this emergency procedure. Keywords: Perimortem Cesarean section, septic shock,eclampsia,postpartumhaemorrhage, maternal mortality.

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Section: Discussionmentioning

confidence: 99%

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Khan¹,

Jamil²,

Butt³

et al. 2023

PJMHS

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“…Hypertension during pregnancy also increases the risk of pre-term birth, placental abruption, and birth by caesarean section [6]. Reducing indirect causes of maternal death is imperative in curbing or decreasing the maternal death rate in Nigeria [7]. Because of the significance of hypertension in pregnancy, care must be taken to diagnose and manage it to reduce the risk associated with it.…”

Section: Introductionmentioning

confidence: 99%

Control of Hypertension in Pregnant Women in Secondary Health Facilities in Nigeria: A Cross-Sectional Study

Adaeze Chukwu,

Atibinye Dotimi,

Ladokun

et al. 2023

TIJPH

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Hypertension is among the non-communicable diseases that complicate pregnancies in women. Diagnosis and control of this condition are important in reducing the risk of maternal and foetal mortality. This study was aimed at determining the prevalence and control of hypertension among pregnant women visiting secondary health care facilities in four Local Government Areas in Lagos (2) and Abuja (Federal Capital Territory) (2), Nigeria. Our findings showed that there was a high prevalence of hypertension in these facilities (50%). Our finding also revealed that the overall level of control was 30.45%, which decreased with time in the course of the management. The control was highest in the first quarter and lowest in the third (last) quarter. The consistent and appropriate use of antihypertensives is important to prevent the complications associated with non-communicable diseases like hypertension during pregnancy. Healthcare providers should therefore advocate early diagnosis and management of hypertension during pregnancy. Keywords: Control, Hypertension, Non-communicable diseases, Pregnancy, Secondary healthcare.

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“…H1N1 influenza was a leading cause of IMDs in Brazil from 2009 to 2010 [ 16 ]; human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome(AIDS) has been a leading cause in sub-Saharan Africa since the 1990s [ 17 - 19 ], and cardiac diseases in the United Kingdom [ 7 ]. Anaemia, diabetes, liver and kidney diseases, cancer, mental disorders, etc., are the other major causes of IMDs worldwide [ 13 , 14 , 16 , 20 ].…”

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confidence: 99%

Levels, trends, causes, place and time of, care-seeking for, and barriers in preventing indirect maternal deaths in Bangladesh: An analysis of national-level household surveys

et al. 2023

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Background Eclampsia, haemorrhage, and other direct causes are the primary burden of maternal mortality in Bangladesh, often reducing attention given to indirect maternal deaths (IMDs). However, Sustainable Development Goals may not be achieved without actions to prevent IMDs. We examined the levels, trends, specific causes, timing, place, and care-seeking, and explored the barriers to IMD prevention. Methods We used three nationally representative surveys conducted in 2001, 2010, and 2016 to examine levels and trends in IMDs. The analysis of specific causes, timing, and place of IMDs, and care-seeking before the deaths was based on 37 IMDs captured in the 2016 survey. Finally, we used thematic content analysis of the open history from the 2016 survey verbal autopsy (VA) questionnaire to explore barriers to IMD prevention. Results After increasing from 51 deaths per 100 000 live births in 2001 to 71 in 2010, the indirect maternal mortality ratio (IMMR) dropped to 38 deaths per 100 000 live births in 2016. In 2016, the indirect causes shared one-fifth of the maternal deaths in Bangladesh. Stroke, cancer, heart disease, and asthma accounted for 80% of the IMDs. IMDs were concentrated in the first trimester of pregnancy (27%) and day 8-42 after delivery (32%). Public health facilities were the main places for care-seeking (48%) and death (49%). Thirty-four (92%) women who died from IMDs sought care from a health facility at least once during their terminal illness. However, most women experienced at least one of the “three delays” of health care. Other barriers were financial insolvency, care-seeking from unqualified providers, lack of health counselling, and the tendency of health facilities to avoid responsibilities. Conclusions IMMR remained unchanged at a high level during the last two decades. The high concentration of IMDs in pregnancy and the large share due to chronic health conditions indicate the need for preconception health check-ups. Awareness of maternal complications, proper care-seeking, and healthy reproductive practices may benefit. Improving regular and emergency maternal service readiness is essential.

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Maternal deaths due to indirect causes: Report from a tertiary care center of a developing country

Cited by 3 publications

References 20 publications

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Control of Hypertension in Pregnant Women in Secondary Health Facilities in Nigeria: A Cross-Sectional Study

Levels, trends, causes, place and time of, care-seeking for, and barriers in preventing indirect maternal deaths in Bangladesh: An analysis of national-level household surveys

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