Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review
Abstract Background In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-05459-y |
| _version_ | 1797836241773789184 |
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| author | Nicola E. Symonds Marianne Vidler Matthew O. Wiens Shazmeen Omar L. Lacey English U. Vivian Ukah J. Mark Ansermino Joseph Ngonzi Lisa M. Bebell Bella Hwang Astrid Christoffersen-Deb Niranjan Kissoon Beth A. Payne |
| author_facet | Nicola E. Symonds Marianne Vidler Matthew O. Wiens Shazmeen Omar L. Lacey English U. Vivian Ukah J. Mark Ansermino Joseph Ngonzi Lisa M. Bebell Bella Hwang Astrid Christoffersen-Deb Niranjan Kissoon Beth A. Payne |
| author_sort | Nicola E. Symonds |
| collection | DOAJ |
| description | Abstract Background In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. Methods A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. Results Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. Conclusions Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. Trial registration PROSPERO registration number: CRD42018103955. |
| first_indexed | 2024-04-09T15:05:31Z |
| format | Article |
| id | doaj.art-c94809426ec84fbb816c137509730063 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-09T15:05:31Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-c94809426ec84fbb816c1375097300632023-04-30T11:31:09ZengBMCBMC Pregnancy and Childbirth1471-23932023-04-0123111010.1186/s12884-023-05459-yRisk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic reviewNicola E. Symonds0Marianne Vidler1Matthew O. Wiens2Shazmeen Omar3L. Lacey English4U. Vivian Ukah5J. Mark Ansermino6Joseph Ngonzi7Lisa M. Bebell8Bella Hwang9Astrid Christoffersen-Deb10Niranjan Kissoon11Beth A. Payne12The Centre for International Child Health, BC Children’s HospitalDepartment of Obstetrics and Gynaecology, University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British ColumbiaDepartment of Obstetrics and Gynaecology, University of British ColumbiaDepartment of Internal Medicine and Pediatrics, Hospital of the University of PennsylvaniaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill UniversityThe Centre for International Child Health, BC Children’s HospitalDepartment of Obstetrics and Gynaecology, Mbarara University of Science and TechnologyInfectious Diseases Division, and Center for Global Health, Massachusetts General Hospital Medical Practice Evaluation CenterThe Centre for International Child Health, BC Children’s HospitalDepartment of Obstetrics and Gynaecology, University of British ColumbiaThe Centre for International Child Health, BC Children’s HospitalSchool of Public and Population Health, University of British ColumbiaAbstract Background In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. Methods A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. Results Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. Conclusions Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. Trial registration PROSPERO registration number: CRD42018103955.https://doi.org/10.1186/s12884-023-05459-yPostpartum periodMaternal mortalityReadmissionPost-discharge riskLow- and middle-income countries |
| spellingShingle | Nicola E. Symonds Marianne Vidler Matthew O. Wiens Shazmeen Omar L. Lacey English U. Vivian Ukah J. Mark Ansermino Joseph Ngonzi Lisa M. Bebell Bella Hwang Astrid Christoffersen-Deb Niranjan Kissoon Beth A. Payne Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review BMC Pregnancy and Childbirth Postpartum period Maternal mortality Readmission Post-discharge risk Low- and middle-income countries |
| title | Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review |
| title_full | Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review |
| title_fullStr | Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review |
| title_full_unstemmed | Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review |
| title_short | Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review |
| title_sort | risk factors for postpartum maternal mortality and hospital readmission in low and middle income countries a systematic review |
| topic | Postpartum period Maternal mortality Readmission Post-discharge risk Low- and middle-income countries |
| url | https://doi.org/10.1186/s12884-023-05459-y |
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