Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.

Vousden, N; Holmes, E; Seed, PT; Gidiri, MF; Goudar, S; Sandall, J; Chinkoyo, S; Kumsa, LY; Brown, A; Charantimath, U; Bellad, M; Nakimuli, A; Vwalika, B; Chappell, LC; Shennan, AH; CRADLE Trial Collaborative Group

Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.

Vousden, N Holmes, E Seed, PT Gidiri, MF Goudar, S Sandall, J

Chinkoyo, S Kumsa, LY Brown, A Charantimath, U Bellad, M Nakimuli, A Vwalika, B Chappell, LC Shennan, AH CRADLE Trial Collaborative Group

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: BJOG : an international journal of obstetrics and gynaecology, 2020, 127, (9), pp. 1082-1089
Issue Date:: 2020-05-07

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Field	Value	Language
dc.contributor.author	Vousden, N
dc.contributor.author	Holmes, E
dc.contributor.author	Seed, PT
dc.contributor.author	Gidiri, MF
dc.contributor.author	Goudar, S
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.contributor.author	Chinkoyo, S
dc.contributor.author	Kumsa, LY
dc.contributor.author	Brown, A
dc.contributor.author	Charantimath, U
dc.contributor.author	Bellad, M
dc.contributor.author	Nakimuli, A
dc.contributor.author	Vwalika, B
dc.contributor.author	Chappell, LC
dc.contributor.author	Shennan, AH
dc.contributor.author	CRADLE Trial Collaborative Group
dc.date.accessioned	2020-08-19T05:35:11Z
dc.date.available	2020-04-22
dc.date.available	2020-08-19T05:35:11Z
dc.date.issued	2020-05-07
dc.identifier.citation	BJOG : an international journal of obstetrics and gynaecology, 2020, 127, (9), pp. 1082-1089
dc.identifier.issn	1470-0328
dc.identifier.issn	1471-0528
dc.identifier.uri	http://hdl.handle.net/10453/142229
dc.description.abstract	OBJECTIVE:The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources. DESIGN:This is a secondary analysis of a stepped-wedge cluster randomised controlled trial. SETTING:This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti. POPULATION:Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion. METHODS:Pregnancy-related deaths were collected prospectively from routine data sources and active case searching. MAIN OUTCOME MEASURES:Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. RESULTS:Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death. CONCLUSIONS:The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. TWEETABLE ABSTRACT:Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	BJOG : an international journal of obstetrics and gynaecology
dc.relation.isbasedon	10.1111/1471-0528.16309
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.title	Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.
dc.type	Journal Article
utslib.citation.volume	127
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-08-19T05:34:41Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	127
utslib.citation.issue	9

Abstract:

OBJECTIVE:The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources. DESIGN:This is a secondary analysis of a stepped-wedge cluster randomised controlled trial. SETTING:This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti. POPULATION:Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion. METHODS:Pregnancy-related deaths were collected prospectively from routine data sources and active case searching. MAIN OUTCOME MEASURES:Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. RESULTS:Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death. CONCLUSIONS:The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. TWEETABLE ABSTRACT:Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.

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http://hdl.handle.net/10453/142229