Severe maternal morbidity in the Asia Pacific: a systematic review and meta-analysis

Manarangi De Silva, MD; Leeanne Panisi, MD; Anthea Lindquist, DPhil; Catherine Cluver, PhD; Anna Middleton, MPH; Benjamin Koete, MD; Joshua P. Vogel, PhD; Susan Walker, PhD; Stephen Tong, PhD; Roxanne Hastie, PhD

The Lancet Regional Health. Western Pacific (Sep 2021)

Severe maternal morbidity in the Asia Pacific: a systematic review and meta-analysis

Manarangi De Silva, MD,
Leeanne Panisi, MD,
Anthea Lindquist, DPhil,
Catherine Cluver, PhD,
Anna Middleton, MPH,
Benjamin Koete, MD,
Joshua P. Vogel, PhD,
Susan Walker, PhD,
Stephen Tong, PhD,
Roxanne Hastie, PhD

Affiliations

Manarangi De Silva, MD: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084
Leeanne Panisi, MD: Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
Anthea Lindquist, DPhil: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084
Catherine Cluver, PhD: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084; Department of Obstetrics and Gynaecology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
Anna Middleton, MPH: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084
Benjamin Koete, MD: Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
Joshua P. Vogel, PhD: Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Australia
Susan Walker, PhD: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084
Stephen Tong, PhD: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084
Roxanne Hastie, PhD: Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia, 3084; Mercy Perinatal, Mercy Hospital for Women, and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital, Heidelberg, Australia, 3084; Corresponding Author. Dr Roxanne Hastie, Department of Obstetrics and gynaecology, University of Melbourne

Journal volume & issue: Vol. 14
p. 100217

Abstract

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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.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

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