Improving pregnancy outcomes in low- and middle-income countries
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COMMENTARY
Open Access
Improving pregnancy outcomes in lowand middle-income countries Robert L. Goldenberg1*, Elizabeth M. McClure2 and Sarah Saleem3 From 2nd International Conference on Maternal and Newborn Health: Translating Research Evidence to Practice Belagavi, India. 26-27 March 2018
Abstract This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone. Keywords: Maternal mortality, Stillbirth, Neonatal mortality, Low-middle income countries
Background Maternal mortality is generally defined as death to the mother during pregnancy or during the first 42 days after birth. In low and some middle-income countries, maternal mortality rates are 50 to 100-fold higher than those seen in high-income countries [1, 2]. Stillbirth is defined as death in utero after 20 to 28 weeks of pregnancy, depending on where the birth occurs [3, 4]. In low-income countries, stillbirth rates are ten to 20-fold higher than those rates seen in high income-countries. Neonatal mortality is defined as death to a live-born baby within 28 days of birth [5, 6]. The neonatal mortality rates in low and middle-income countries are often tenfold the rates in high-income countries. Many current low-income country mortality rates are similar to the rates in high-income countries from the early 1900’s. This paper first explores the causes of maternal mortality, stillbirth and neonatal death, and then considers why the rates of each outcome have improved in * Correspondence: [email protected] 1 Department of OBGYN Columbia University, New York, NY, USA Full list of author information is available at the end of the article
high-income countries. Finally, we review recommendations regarding interventions to reduce these mortalities in low- and middle-income countries.
Etiology of maternal mortality
In most low and some middle-income countries, the causes of maternal mortality include hemorrhage, hypertensive diseases and maternal infections [7–11]. The timing of hemorrhage is
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