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A record-based cross-sectional analytical study was conducted in four randomly selected governorates: Kafr El-Sheikh, El-Behira, (Lower Egypt) and Assiut, and Fayoum (Upper Egypt). Data from 541 maternal deaths were analyzed, revealing that 37.7% occurred in Assuit, 28.5% in El-Behira, 22.7% in Fayoum, and 11.1% in Kafr El-Sheik. The mean age of the studied population was 28.9\u2009\u00b1\u20096.4 years, with 39.0% having 1\u20132 children and 26.8% being nulliparous. Direct causes, including postpartum haemorrhage, preeclampsia, and embolism, accounted for 47.5% of deaths. As one of indirect causes of deaths, COVID-19 was diagnosed in 25.3%, it was the sole cause in 75.0% of them. Multivariable analysis identified the year 2021 (adjusted odds ratio (aOR)\u2009=\u20093.32; 95% CI, 1.9\u20135.81), residence in Lower Egypt (aOR\u2009=\u20095.15; 95% CI, 2.61\u201310.18), and hospital referral refusals (aOR\u2009=\u20098.72; 95% CI, 1.73\u201344.0) as key predictors of COVID-19-associated MM. The overall MMR increased between 2018 and 2021 with significant increases observed in Fayoum (from 39.25 to 71.65; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and Kafr El-Sheikh (from 36.44 to 56.6; <jats:italic>p<\/jats:italic>\u2009=\u20090.032). Yearly comparisons revealed significant inter-governorate differences in all years except 2021 (<jats:italic>p<\/jats:italic>\u2009=\u20090.15), with Assuit maintaining the highest MMR. Although the national MMR increased from 44.1 (pre-COVID-19) to 55.9 (post-COVID-19), this change was not statistically significant (<jats:italic>p<\/jats:italic>\u2009=\u20090.236). The findings highlight an alarming rise in maternal deaths and underscore the need for targeted interventions to address the direct causes of MM and improve healthcare access during crises like the COVID-19 pandemic.<\/jats:p>","DOI":"10.1038\/s41598-025-15818-8","type":"journal-article","created":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T02:01:17Z","timestamp":1756519277000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal mortality in Egypt during the COVID-19 pandemic using record-based data from January 2020 to December 2021"],"prefix":"10.1038","volume":"15","author":[{"given":"Shaimaa Abdallah","family":"Gebili","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3585-8827","authenticated-orcid":false,"given":"Norhan Hassan","family":"Hekal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neamat Hamdy","family":"Elsawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esraa Morshedy","family":"Beltagy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walaa Mohamed","family":"Kandil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebtisam","family":"Hassanin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatem","family":"gamaleldin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud M.","family":"Tolbah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Mohamed","family":"Abady","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-706X","authenticated-orcid":false,"given":"Ramy Mohamed","family":"Ghazy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"unstructured":"World Health Organization. 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