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Maternal mortality in modern world

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.279

Abstract

Aim: to analyze the causes and level of global maternal mortality (MM) according to the data published within the last 7 years.

Materials and Methods. Search for publications in the PubMed/MEDLINE database was conducted according to the criteria: metaanalysis, free full-text, English, 2015–2021 period. The PICO principle (Patient/Problem, Intervention, Comparison, Outcome) and the keywords "maternal mortality causes", "maternal death causes", "maternal outcomes" were used. The search was finished on October 13, 2021 after retrieving 137 results.

Results. The rate of MM and cause pattern has been changing during COVID-19 pandemic. The first weeks of the COVID-19 lockdown showed that in-hospital mortality among pregnant women increased from 0.13 up to 0.20 % (p = 0.01) and in MM the proportion of respiratory diseases elevated up to 32 % versus 5.6%. Certain geographic regions of the world showed that MM due to COVID-19 reached extremely high values extending 3399 per 100,000 live births as well as increased general MM rate. Heart and vascular diseases (pericarditis, myocardial infarction, thromboembolism) have a significant position among the causes of MM. The rate of MM due to cardiovascular disease was inversely related to the population income level. Cardiomyopathy is the cause of death in 4 % (95 % confidence interval (95 % CI) = 2–7) of mothers in developed countries and 14 % (95 % CI = 10–18) in developing countries. The mortality rate 6 weeks after delivery among women with pregnancy-related myocardial infarction was 5.03 % (95 % Cl = 3,78–6,27), whereas it associated with thromboembolism among women with a mechanical heart valve was related to the agent used to prevent thrombosis, ranging from 0.9 (95 % CI = 0.1–1.6) for vitamin K antagonists up to 3.4 (95 % CI = 0–7.7) for unfractionated heparin per 100 pregnancies with a mechanical heart valve. After 2000, the proportion of anesthesia among immediate MМ causes decreased from 3.5 % (95 % CI = 2.9–4.3) down to 2.4 % (95 % CI = 1.9–2.9) in low- and middleincome countries. High MM odds due to maladjusted pregnancy are still observed: OR (odds ratio) = 17 (95 % CI = 9.6–28.8) for hypertension, OR = 3.70 (95 % CI = 1.72–7.99) for HELLP syndrome with acute kidney injury. Severe obstetric complications cause MM in sub-Saharan Africa and South Asia: bleeding (OR = 28.8; 95 % CI = 20.3–40.7), preeclampsia or eclampsia (OR = 9.13; 95 % CI = 6.10–13.7), maternal infections in antenatal period (OR = 2.80; 95 % CI = 1.63–4.80). About 67 % of pregnant women in such countries obtain no antenatal care (OR = 2.80; 95% CI = 1.63–4.80), predominantly giving birth at home in sub-Saharan Africa. In Ethiopia, ММ results from obstructed home delivery resulting in maternal death in 17.27 %, where uterine rupture is cause of death in 7.75 % of women.

Conclusion. The COVID-19 pandemic contributed a lot to MM. Diseases of the cardiovascular system markedly elevate the MM risk and long-term mortality after delivery. For countries with traditionally home births in the absence of medical care, a high MM remains due to complicated and protracted labor complicated by uterine rupture.

About the Author

E. I. Baranovskaya
Belarusian State Medical University
Belarus

Elena I. Baranovskaya – MD, Sci Med, Professor, Department of Obstetrics and Gynecology

83 Dzerzhinsky Avenue, Minsk 220116



References

1. Trends in maternal mortality: 2000 to 2017. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization, 2019. 119 р. https://www.unfpa.org/sites/default/files/pub-pdf/Maternal_mortality_report.pdf.

2. United Nations. Department of Economic and Social Affairs. Statistics Division. SDG Indicators Database. Available at: https://unstats.un.org/sdgs/UNSDG/IndDatabasePage.

3. Maternal mortality. World Health Organization, 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.

4. Aftab F., Ahmed I., Ahmed S. et al.; Alliance for Maternal and Newborn Health Improvement (AMANHI) maternal morbidity study group. Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A populationbased prospective cohort study in 8 countries. PLoS Med. 2021;18(6):e1003644. https://doi.org/10.1371/journal.pmed.1003644.

5. Kerpen K., Koutrolou-Sotiropoulou P., Zhu C. et al. Disparities in death rates in women with peripartum cardiomyopathy between advanced and developing countries: A systematic review and meta-analysis. Arch Cardiovasc Dis. 2019;112(3):187–98. https://doi.org/10.1016/j.acvd.2018.10.002.

6. Mocumbi A.O., Sliwa K., Soma-Pillay P. Medical disease as a cause of maternal mortality: the pre-imminence of cardiovascular pathology. Cardiovasc J Afr. 2016;27(2):84–8. https://doi.org/10.5830/CVJA-2016-018.

7. Yang J., D'Souza R., Kharrat A. et al. COVID-19 pandemic and populationlevel pregnancy and neonatal outcomes: a living systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021;100(10):1756–70. https://doi.org/10.1111/aogs.14206.

8. Kumari V., Mehta K., Choudhary R. COVID-19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Glob Health. 2020;8(9):e1116–e1117. https://doi.org/10.1016/S2214-109X(20)30319-3.

9. Pettirosso E., Giles M., Cole S., Rees M. COVID-19 and pregnancy: A review of clinical characteristics, obstetric outcomes and vertical transmission. Aust N Z J Obstet Gynaecol. 2020;60(5):640–59. https://doi.org/10.1111/ajo.13204.

10. Sun M., Xu G., Yang Y. et al. Evidence of mother-to-newborn infection with COVID-19. Br J Anaesth. 2020;125(2):e245–e247. https://doi.org/10.1016/j.bja.2020.04.066.

11. Hantoushzadeh S., Shamshirsaz A.A., Aleyasin A. et al. Maternal death due to COVID-19. Am J Obstet Gynecol. 2020;223(1):109.e1-109.e16. https://doi.org/10.1016/j.ajog.2020.04.030.

12. Di Toro F., Gjoka M., Di Lorenzo G. et al. Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(1):36–46. https://doi.org/10.1016/j.cmi.2020.10.007.

13. Knight M., Bunch K., Vousden N. et al.; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. https://doi.org/10.1136/bmj.m2107.

14. Siqueira T.S., Silva J.R.S., Souza M.D.R. et al. Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study. Lancet Reg Health Am. 2021;3:100076. https://doi.org/10.1016/j.lana.2021.100076.

15. Lumbreras-Marquez M.I., Campos-Zamora M., Seifert S.M. et al. Excess Maternal Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Mexico. Obstet Gynecol. 2020;136(6):1114–6. https://doi.org/10.1097/AOG.0000000000004140.

16. Campanharo F.F., Cecatti J.G., Haddad S.M. et al.; Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group. The Impact of cardiac diseases during pregnancy on severe maternal morbidity and mortality in Brazil. PLoS One. 2015;10(12):e0144385. https://doi.org/10.1371/journal.pone.0144385.

17. Gibson P., Narous M., Firoz T. et al.; WHO Maternal Morbidity Working Group. Incidence of myocardial infarction in pregnancy: a systematic review and meta-analysis of population-based studies. Eur Heart J Qual Care Clin Outcomes. 2017;3(3):198–207. https://doi.org/10.1093/ehjqcco/qcw060.

18. D'Souza R., Ostro J., Shah P.S. et al. Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis. Eur Heart J. 2017;38(19):1509–16. https://doi.org/10.1093/eurheartj/ehx032.

19. Young M.F., Oaks B.M., Tandon S. et al. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci. 2019;1450(1):47–68. https://doi.org/10.1111/nyas.14093.

20. Young M.F. Maternal anaemia and risk of mortality: a call for action. Lancet Glob Health. 2018;6(5):e479–e480. https://doi.org/10.1016/S2214-109X(18)30185-2.

21. Daru J., Zamora J., Fernández-Félix B.M. et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. 2018;6(5):e548–e554. https://doi.org/10.1016/S2214-109X(18)30078-0.

22. ACOG Committee Opinion No. 761. Cesarean delivery on maternal request. Obstet Gynecol. 2019;133(1):e73–e77. https://doi.org/10.1097/AOG.0000000000003006.

23. Liu X., Landon M.B., Cheng W., Chen Y. Cesarean delivery on maternal request in China: what are the risks and benefits? Am J Obstet Gynecol. 2015;212(6):817.e1–9. https://doi.org/10.1016/j.ajog.2015.01.043.

24. Mascarello K.C., Horta B.L., Silveira M.F. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica. 2017;51:105. https://doi.org/10.11606/S1518-8787.2017051000389.

25. Sobhy S., Zamora J., Dharmarajah K. et al. Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(5):e320–7. https://doi.org/10.1016/S2214-109X(16)30003-1.

26. Gemechu K.S., Assefa N., Mengistie B. Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis. Womens Health (Lond). 2020;16:1745506520973105. https://doi.org/10.1177/1745506520973105.

27. Liu Q., Ling G.J., Zhang S.Q. et al. Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20(1):657. https://doi.org/10.1186/s12884-020-03346-4.

28. Wang H.Y., Jiang Q., Shi H. et al. Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis. Sci Rep. 2016;6:28826. https://doi.org/10.1038/srep28826.

29. Ayenew A.A. Incidence, causes, and maternofetal outcomes of obstructed labor in Ethiopia: systematic review and meta-analysis. Reprod Health. 2021;18(1):61. https://doi.org/10.1186/s12978-021-01103-0.

30. Desta M., Kassa G.M., Getaneh T. et al. Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis. PLoS One. 2021;(4):e0245977. https://doi.org/10.1371/journal.pone.0245977.

31. Ahmed D.M., Mengistu T.S., Endalamaw A.G. Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study. BMC Pregnancy Childbirth. 2018;18(1):447. https://doi.org/10.1186/s12884-018-2083-8.

32. Mengistie H., Amenu D., Hiko D. Maternal and perinatal outcomes of uterine rupture patients among mothers who delivered at mizan aman general hospital, SNNPR, south west Ethiopia; a five year retrospective hospital based study. MOJ Womens Health. 2016;2(1):13–23. https://doi.org/10.15406/mojwh.2016.02.00019.


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For citations:


Baranovskaya E.I. Maternal mortality in modern world. Obstetrics, Gynecology and Reproduction. 2022;16(3):296-305. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.279

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)