Sarah Saleem1, Elizabeth M McClure2, Shivaprasad S Goudar3, Archana Patel4, Fabian Esamai5, Ana Garces6, Elwyn Chomba7, Fernando Althabe8, Janet Moore2, Bhalachandra Kodkany3, Omrana Pasha1, Jose Belizan8, Albert Mayansyan9, Richard J Derman10, Patricia L Hibberd11, Edward A Liechty12, Nancy F Krebs13, K Michael Hambidge13, Pierre Buekens14, Waldemar A Carlo9, Linda L Wright15, Marion Koso-Thomas15, Alan H Jobe16, Robert L Goldenberg17. 1. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan . 2. Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA). 3. KLE University's JN Medical College, Belgaum, India . 4. Lata Medical Research Foundation, Nagpur, India . 5. Department of Pediatrics, Moi University, Eldoret, Kenya . 6. Universidad Francisco Marroquin, Guatemala City, Guatemala . 7. Department of Pediatrics, University of Zambia, Lusaka, Zambia . 8. Institute of Clinical Effectiveness, Buenos Aires, Argentina . 9. University of North Carolina at Chapel Hill, Chapel Hill, USA . 10. Department of Obstetrics and Gynecology, Christiana Health Care, Newark, USA . 11. Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA . 12. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA . 13. Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA . 14. Tulane University School of Public Health and Tropical Medicine, New Orleans, USA . 15. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA . 16. Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, USA . 17. Department of Obstetrics and Gynecology, Columbia University, New York, USA .
Abstract
OBJECTIVE: To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. METHODS: A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. FINDINGS: Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77). CONCLUSION: Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
OBJECTIVE: To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. METHODS: A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. FINDINGS: Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77). CONCLUSION: Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
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Authors: Samantha Y Rowe; David H Peters; Kathleen A Holloway; John Chalker; Dennis Ross-Degnan; Alexander K Rowe Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
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