{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T10:56:18Z","timestamp":1773399378553,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,5,13]],"date-time":"2023-05-13T00:00:00Z","timestamp":1683936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To perform an in\u2010depth analysis and evaluate the causes of maternal deaths in a university hospital in Southern Thailand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective descriptive study was conducted. Medical records of all women who died during pregnancy or within 42\u2009days of termination of pregnancy at Songklanagarind Hospital from January 2006 to December 2021 were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 51\u2009910 live births during the 16\u2010year period and 68 maternal deaths (31 of direct cause, 36 of indirect cause, and one of unknown cause). The maternal mortality ratio was 131 per 100\u2009000 live births. There was a decreasing trend in the maternal mortality ratio, especially during the past 4\u2009years. The leading causes of death were cardiac disease (<jats:italic>n<\/jats:italic>\u2009=\u200917), hypertensive disorders in pregnancy (<jats:italic>n<\/jats:italic>\u2009=\u20099), and postpartum hemorrhage (<jats:italic>n<\/jats:italic>\u2009=\u20097). The most common indirect causes of maternal death were cardiac disease, hematologic disease, and dengue hemorrhagic fever. There was a decreasing trend in indirect to direct deaths ratios during three study periods. Ratios in 2006 to 2010, 2011 to 2015, and 2016 to 2021 were 1.6, 1.4, and 0.5, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The three leading causes of death were cardiac disease, hypertensive disorders in pregnancy, and postpartum hemorrhage. Improvements in the quality of obstetric care at all hospital levels are required.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14856","type":"journal-article","created":{"date-parts":[[2023,5,13]],"date-time":"2023-05-13T07:24:05Z","timestamp":1683962645000},"page":"579-585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An in\u2010depth analysis of maternal mortality in a quaternary university hospital in Southern Thailand: A 16\u2010year experience"],"prefix":"10.1002","volume":"163","author":[{"given":"Krantarat","family":"Peeyananjarassri","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ninizna","family":"Ratipann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8634-2359","authenticated-orcid":false,"given":"Chitkasaem","family":"Suwanrath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sutham","family":"Pinjaroen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natthicha","family":"Chainarong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanapan","family":"Choobun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University  Songkhla Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health Organization.Maternal mortality ratio (modeled estimate per 100 000 live births)\u2010Thailand East Asia & Pacific [Internet].2016Accessed August 12 2022.https:\/\/data.worldbank.org\/indicator\/SH.STA.MMRT.NE?end=2016&locations=Z4&start=2016&view=map"},{"key":"e_1_2_10_3_1","unstructured":"Department of Health Ministry of Public Health.Thailand maternal death surveillance and response guideline [Internet].2020Accessed April 8 2023.https:\/\/hp.anamai.moph.go.th\/th\/mch\u2010emag\/download\/?did=203656&id=69435&reload="},{"key":"e_1_2_10_4_1","unstructured":"Department of Health Ministry of Public Health.Maternal death situation in Thailand 2019\u20132020 [Internet].2020Accessed April 8 2023.https:\/\/hp.anamai.moph.go.th\/web\u2010upload\/4xceb3b571ddb70741ad132d75876bc41d\/tinymce\/OPDC\/OPDC2564\u2010F\/IDC1_6\/opdc_2564_IDC1\u20106_01.pdf"},{"key":"e_1_2_10_5_1","unstructured":"Department of Health Ministry of Public Health.Maternal death situation in Thailand 2021 [Internet].2021Accessed April 8 2023.https:\/\/hp.anamai.moph.go.th\/web\u2010upload\/4xceb3b571ddb70741ad132d75876bc41d\/tinymce\/OPDC\/OPDC2565\u2010F\/IDC1_6\/opdc_2565_IDC1\u20106_01.pdf"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13172"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30184-8"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.20-10-e561"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.055"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.17661"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004361"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-2830-5"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-016-0087-z"},{"key":"e_1_2_10_14_1","first-page":"308","article-title":"A 10\u2010year review of maternal mortality in Chon Buri hospital, Thailand","volume":"76","author":"Pinchun P","year":"1993","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdab297"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2021.09.009"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm023"},{"key":"e_1_2_10_18_1","unstructured":"World Health Organization.The WHO Application of ICD\u201010 to Deaths during Pregnancy Childbirth and Puerperium: ICD\u2010MM. 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