{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:49:04Z","timestamp":1792644544469,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"s1","license":[{"start":{"date-parts":[[2014,3,18]],"date-time":"2014-03-18T00:00:00Z","timestamp":1395100800000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Secondary analysis of the\n                      <jats:styled-content style=\"fixed-case\">WHO M<\/jats:styled-content>\n                      ulticountry\n                      <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>\n                      urvey on\n                      <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>\n                      aternal and\n                      <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>\n                      ewborn\n                      <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>\n                      ealth.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\n                      A total of 359 health facilities in 29 countries in\n                      <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>\n                      frica,\n                      <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>\n                      sia,\n                      <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>\n                      atin\n                      <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>\n                      merica, and the\n                      <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>\n                      iddle\n                      <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>\n                      ast.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>A total of 314\u00a0623 pregnant women admitted to the participating facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Amongst 314\u00a0623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589\/2822; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      20.1\u201321.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio,\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      , 7.0; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      6.6\u20137.4), severe maternal outcomes (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      27.9; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      24.7\u201331.6), and perinatal mortality (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      3.8; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      3.5\u20134.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Indirect causes were responsible for about one\u2010fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.12647","type":"journal-article","created":{"date-parts":[[2014,3,18]],"date-time":"2014-03-18T07:53:38Z","timestamp":1395129218000},"page":"32-39","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Indirect causes of severe adverse maternal outcomes: a secondary analysis of the\n                    <scp>WHO<\/scp>\n                    Multicountry Survey on Maternal and Newborn Health"],"prefix":"10.1111","volume":"121","author":[{"given":"P","family":"Lumbiganon","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Faculty of Medicine Khon Kaen University Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Laopaiboon","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Demography Faculty of Public Health Khon Kaen University Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Intarut","sequence":"additional","affiliation":[{"name":"Department of Biostatistics &amp; Demography Faculty of Public Health Khon Kaen University Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JP","family":"Vogel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences School of Population Health University of Western Australia Crawley WA Australia"},{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JP","family":"Souza","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"G\u00fclmezoglu","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Health Policy National Center for Child Health and Development Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60518-1"},{"key":"e_1_2_6_3_1","first-page":"105","article-title":"Maternal mortality in a tertiary care hospital: a 10\u2010year review","volume":"4","author":"Murthy BK","year":"2013","journal-title":"Int J Prev Med"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01249.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.10.023"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.703719"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2301-y"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2011.640373"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.04.014"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02726.x"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.007"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60686-8"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-11-286"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-71"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12053"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-11-102"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2004.00313.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S46872"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.4314\/gmj.v45i2.68929"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181af33e6"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2012.03.011"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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