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

TY - JOUR

T1 - Incidence and characteristics of pregnancy-related death across ten low and middle-income geographical regions

T2 - secondary analysis of a cluster randomised controlled trial

AU - CRADLE Trial Collaborative Group

AU - Vousden, Nicola

AU - Holmes, Elodie

AU - Seed, Paul T

AU - Gidiri, Muchabayiwa Francis

AU - Goudar, Shivaprasad

AU - Sandall, Jane

AU - Chinkoyo, Sebastian

AU - Kumsa, Lomi Yadeta

AU - Brown, Adrian

AU - Charantimath, Umesh

AU - Bellad, Mrutyunjaya

AU - Nakimuli, Annettee

AU - Vwalika, Bellington

AU - Chappell, Lucy C

AU - Shennan, Andrew H

N1 - This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1471-0528.16309 This article is protected by copyright. All rights reserved

PY - 2020/8/1

Y1 - 2020/8/1

N2 - 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.

AB - 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.

KW - Epidemiology

KW - low and middle resource

KW - maternal mortality

UR - http://www.scopus.com/inward/record.url?scp=85085686345&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.16309

DO - 10.1111/1471-0528.16309

M3 - Article

C2 - 32383337

SN - 1470-0328

VL - 127

SP - 1082

EP - 1089

JO - BJOG

JF - BJOG

IS - 9

ER -