TY - JOUR
T1 - Severe maternal morbidity in the Asia Pacific
T2 - a systematic review and meta-analysis
AU - De Silva, Manarangi
AU - Panisi, Leeanne
AU - Lindquist, Anthea
AU - Cluver, Catherine
AU - Middleton, Anna
AU - Koete, Benjamin
AU - Vogel, Joshua P.
AU - Walker, Susan
AU - Tong, Stephen
AU - Hastie, Roxanne
N1 - Funding Information:
We are grateful to the staff at the Bailieu Library, The University of Melbourne, for assistance in development of the search strategy and Mr. Naveen De Silva for his generous assistance in creating the figures for this manuscript. Funding bodies had no role in study design, data collection, data analysis, data representation, or writing of the manuscript. Data is available upon reasonable request to the corresponding author. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations, Evidence before this study, Many pregnant women continue to suffer severe maternal morbidity (or a maternal “near miss” event) around the world. While causes and risk factors for maternal deaths have been extensively investigated, severe maternal morbidity has not had the same focus, particularly in low and lower-and-middle-income countries (LMIC). In settings where absolute numbers of maternal deaths are low or underreported, monitoring rates of severe maternal morbidity/near misses can be used to better assess the quality of health systems. The Asia-Pacific region is diverse with a high number of LMICs, each with unique sociocultural and geographical challenges that have the potential to contribute to poor maternal outcomes. Assessing maternal morbidity is essential to improving maternal health in this region. Our systematic review is the first to characterise severe maternal morbidity across the entire Asia Pacific. 30,183,608 pregnancies and 100,011 near miss cases were included. The total proportion of near misses was 4•4 cases (95% CI 4•3 - 4.5) per 1000 total births across 27 countries, with significant variation among subregions and individual countries. Unfortunately, there were many countries in the region that were underrepresented, or entirely missing. LMICs had the greatest proportion of near-miss cases, with the Western Pacific subregion (the area including Papua New Guinea and Timor Leste) having the highest overall proportions of near misses. Massive haemorrhage and eclampsia were the main causes of maternal near miss in the Asia Pacific region. There are a disproportionate number of women who experience adverse consequences of pregnancy and childbirth in LMICs in the Asia Pacific. Massive postpartum haemorrhage and eclampsia are major contributors to adverse maternal outcomes, though both are largely preventable. Our findings further demonstrate the utility of near miss in evaluating quality of maternal health services. These results should help policy makers and leaders understand the main causes of maternal morbidity and which areas are most heavily burdened within the Asia-Pacific region. This evidence can be used to inform targeted interventions to help reduce the number of preventable maternal deaths and near misses in the Asia Pacific region.
Publisher Copyright:
© 2021
PY - 2021/9
Y1 - 2021/9
N2 - Background: Monitoring rates of severe maternal morbidity (such as eclampsia and uterine rupture) is useful to assess the quality of obstetric care, particularly in low and lower-middle-income countries (LMICs). Methods: We undertook a systematic review characterising the proportion and causes of severe maternal morbidity in the Asia Pacific region. We searched Medline, Embase, Cochrane CENTRAL library and the World Health Organization Western Pacific Index database for studies in the Asia-Pacific reporting maternal morbidity/near miss using a predefined search strategy. We included cohort, case-control and cross-sectional studies published in English before September 2020. A meta-analysis was performed calculating the overall proportion of near miss events by sub-region, country, near miss definition, economic status, setting and cause using a random-effects model. Findings: We identified 26,232 articles, screened 24,306 and retrieved 454 full text articles. Of these, 197 studies spanning 27 countries were included. 13 countries in the region were not represented. There were 30,183,608 pregnancies and 100,011 near misses included. The total proportion of near miss events was 4•4 (95% CI 4•3-4•5) per 1000 total births. The greatest proportion of near misses were found in the Western Pacific region (around Papua New Guinea) at 11•8 per 1000 births (95% CI 6•6-17•1; I2 96.05%). Low-income countries displayed the greatest proportion of near misses (13•4, 95% CI 6•0-20•7), followed by lower-middle income countries (11•1; 95% CI 10•4 - 11•9). High-income countries had the lowest proportion (2•2, 95% CI 2•1-2•3). Postpartum haemorrhage was the most common near miss event (5•9, 95% CI 4•5-7•2), followed by eclampsia (2•7, 95% CI 2•4 – 2•9). Interpretation: There is a high burden of severe maternal morbidity in the Asia-Pacific. LMICs are disproportionately affected. Most of the common causes are preventable. This provides an opportunity to implement targeted interventions which could have major clinical impact.
AB - Background: Monitoring rates of severe maternal morbidity (such as eclampsia and uterine rupture) is useful to assess the quality of obstetric care, particularly in low and lower-middle-income countries (LMICs). Methods: We undertook a systematic review characterising the proportion and causes of severe maternal morbidity in the Asia Pacific region. We searched Medline, Embase, Cochrane CENTRAL library and the World Health Organization Western Pacific Index database for studies in the Asia-Pacific reporting maternal morbidity/near miss using a predefined search strategy. We included cohort, case-control and cross-sectional studies published in English before September 2020. A meta-analysis was performed calculating the overall proportion of near miss events by sub-region, country, near miss definition, economic status, setting and cause using a random-effects model. Findings: We identified 26,232 articles, screened 24,306 and retrieved 454 full text articles. Of these, 197 studies spanning 27 countries were included. 13 countries in the region were not represented. There were 30,183,608 pregnancies and 100,011 near misses included. The total proportion of near miss events was 4•4 (95% CI 4•3-4•5) per 1000 total births. The greatest proportion of near misses were found in the Western Pacific region (around Papua New Guinea) at 11•8 per 1000 births (95% CI 6•6-17•1; I2 96.05%). Low-income countries displayed the greatest proportion of near misses (13•4, 95% CI 6•0-20•7), followed by lower-middle income countries (11•1; 95% CI 10•4 - 11•9). High-income countries had the lowest proportion (2•2, 95% CI 2•1-2•3). Postpartum haemorrhage was the most common near miss event (5•9, 95% CI 4•5-7•2), followed by eclampsia (2•7, 95% CI 2•4 – 2•9). Interpretation: There is a high burden of severe maternal morbidity in the Asia-Pacific. LMICs are disproportionately affected. Most of the common causes are preventable. This provides an opportunity to implement targeted interventions which could have major clinical impact.
KW - Asia-Pacific
KW - LMIC
KW - Maternal death
KW - Maternal morbidity
KW - Near-miss
UR - http://www.scopus.com/inward/record.url?scp=85110664672&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2021.100217
DO - 10.1016/j.lanwpc.2021.100217
M3 - Article
C2 - 34528001
AN - SCOPUS:85110664672
SN - 2666-6065
VL - 14
JO - The Lancet Regional Health - Western Pacific
JF - The Lancet Regional Health - Western Pacific
M1 - 100217
ER -
