Progress on the Maternal Mortality Ratio Reduction in Wuhan, China in 2001–2012

Yang, Shaoping; Zhang, Bin; Zhao, Jing; Wang, Jing; Flick, Louise H.; Qian, Zhengmin; Zhang, Dan; Hui, Mei

doi:10.1371/journal.pone.0089510

Cited by 17 publications

(22 citation statements)

References 16 publications

(17 reference statements)

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“…The eastern regional level of economic development and maternal health was better than that of the central and western regions of China with greater territory [ 5 , 14 ]. The MMR in Hunan province was higher than that in Henan province, with 17.3 in 2009 [ 7 ], and Wuhan city in Hubei province, with 10.88 to 10.63 from 2009 to 2012[ 15 ]. Jiangsu province in the east of China had the lowest MMR, 1.2 in 2011, which then remained at 1–2 over the next few years [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological analysis of maternal deaths in Hunan province in China between 2009 and 2014

Xiong

Zeng

et al. 2018

PLoS ONE

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BackgroundThe control of maternal deaths continues to be a significant public health issue and commands an enormous amount of attention, especially under the future family planning policy. Here, we describe the epidemiology and trends of maternal deaths in Hunan province, and give several policy implications.MethodsMaternal deaths in Hunan province between 2009 and 2014 were retrospectively reviewed and analyzed. Cochran-Armitage trend test was used to assess the time trends of maternal mortality rates. Binary logistic regression analyses were undertaken to identify the factors that were associated with unavoidable maternal deaths.ResultsIn total, there were 987 maternal deaths, with the overall MMR declining by 45.24%. The most common causes of maternal death during this period were pregnancy complications (28.37%), obstetric hemorrhage (25.33%), and amniotic fluid embolism (15.70%). Obstetric hemorrhage (28.14%) was higher in rural areas, while pregnancy complications were higher (29.27%) in urban areas. In all, 627 (63.5%) deaths were avoidable. The risk factors associated with unavoidable maternal deaths was above 35 years (aOR = 1.80 95%CI: 1.27–2.55), without prenatal examination (aOR = 8.97 95%CI: 1.11–7.78), low household incomes (aOR = 1.15 95%CI: 1.02–1.29), without adopting the new way to deliver (aOR = 5.15 95%CI: 3.20–8.31), and death location (aOR = 1.09 95%CI: 1.02–1.18). The most frequent and important factors associated with avoidable deaths was improper knowledge and skills of the county medical institutions.ConclusionsModerate progress was made in reducing the MMR in Hunan province. The government should aim to improve the basic midwifery skills in rural areas and the obstetric emergency rescue service for critically ill pregnant women in urban areas, and strengthen training to improve knowledge and skills in medical institutions in counties.

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Section: Discussionmentioning

confidence: 99%

Epidemiological analysis of maternal deaths in Hunan province in China between 2009 and 2014

Xiong

Zeng

et al. 2018

PLoS ONE

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“…In China, the increase in MNM incidence was caused by many factors, including increase in maternal age, prepregnancy obesity, pre-existing chronic medical conditions, and cesarean delivery. [ 14 , 22 ]…”

Section: Discussionmentioning

confidence: 99%

“…The causes of maternal death were related to biomedical, reproductive, health service, socioeconomic, and cultural factors. [ 14 ] The 3 major direct causes of maternal death in China were postpartum hemorrhage (27.0%), amniotic embolism (12.9%), and heart disease (10.9%), which was followed by gestational hypertension (8.0%) in 2012. [ 15 ] MMR varied between urban and rural areas.…”

Section: Introductionmentioning

confidence: 99%

A retrospective cohort study of risk factors and pregnancy outcomes in 14,014 Chinese pregnant women

et al. 2018

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This study aims to investigate major complications or symptoms of pregnant women, causes of maternal near-miss, and issues that are relevant to severe maternal disease.A retrospective analysis was performed in the “maternal individual investigation form,” which included all critical maternity patients admitted to the First Affiliated Hospital of Anhui Medical University from January 1, 2012 to September 31, 2015.A total of 14,014 pregnant patients who delivered at 28 to 42 weeks of gestation were included. Eight thousand eighty-six patients experienced complications or symptoms, and top 7 of these were postpartum hemorrhage, hypertension during pregnancy, diabetes, anemia, hepatopathy, nephroma, and connective tissue disease, of which the morbidity were 11.92%, 10.15%, 9.34%, 8.57%, 3.13%. 0.56%, and 0.55%, respectively. Delivery times, gestational weeks, and informal pregnancy examinations had significant correlation with maternal near-miss (P < .05); nevertheless, the age at pregnancy, number of pregnancies, and education were not so significant (P > .05). Two hundred sixty-five patients had severe maternal diseases (maternal near miss), and the top 5 causes for severe maternal morbidity were massive blood transfusion, thrombocytopenia, clinical feature of shock, uterus removal induced by uterus infection or bleeding, and coagulation dysfunction, of which the morbidity were 24.15%, 18.87%, 13.58%, 9.43%, and 6.79%, respectively.Delivery times, gestational weeks, and informal pregnancy examinations should be considered in maternal near miss patients. Moreover, hypertensive disorders during pregnancy, postpartum hemorrhage, anemia, thrombocytopenia, hepatopathy, and cardiopathy were the principal causes of maternal near miss. Therefore, the monitoring of these principal causes of severe maternity near miss is important for reducing the maternal morbidity and mortality.

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“…Forty‐seven maternal mortality reports were included, reporting on a total of 38,486 maternal deaths in LMIC [13‐19,22‐61]. Study selection is summarised in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Maternal mortality due to cardiac disease in low‐ and middle‐income countries

Heemelaar

Petrus

Knight

et al. 2020

Tropical Med Int Health

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objectives To assess the frequency of maternal death (MD) due to cardiac disease in low-and middle-income countries (LMIC).methods Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital-based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac-related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac-related MD/100 000 live births) and proportion of cardiac-related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country.results Forty-seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac-related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac-related MD was higher in countries with a lower MMR.conclusions The burden of cardiac-related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called 'obstetric transition': pre-existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.keywords cardiac disease, maternal mortality, low-and middle-income countries Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 17 (partnerships for the goals)

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Progress on the Maternal Mortality Ratio Reduction in Wuhan, China in 2001–2012

Cited by 17 publications

References 16 publications

Epidemiological analysis of maternal deaths in Hunan province in China between 2009 and 2014

Epidemiological analysis of maternal deaths in Hunan province in China between 2009 and 2014

A retrospective cohort study of risk factors and pregnancy outcomes in 14,014 Chinese pregnant women

Maternal mortality due to cardiac disease in low‐ and middle‐income countries

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