{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T02:53:57Z","timestamp":1780109637746,"version":"3.54.0"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T00:00:00Z","timestamp":1591056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this article is to describe the incidence and characteristics of pregnancy\u2010related death in low\u2010 and middle\u2010resource settings, in relation to the availability of key obstetric resources.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This is a secondary analysis of a stepped\u2010wedge cluster randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>This trial was undertaken at ten sites across eight low\u2010 and middle\u2010income countries in sub\u2010Saharan Africa, India and Haiti.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Institutional\u2010level consent was obtained and all women presenting for maternity care were eligible for inclusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pregnancy\u2010related deaths were collected prospectively from routine data sources and active case searching.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Pregnancy\u2010related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 20\u00a0months, in 536\u00a0233 deliveries there were 998 maternal deaths (18.6\/10\u00a0000, range 28\/10\u00a0000\u2013630\/10\u00a0000). The leading causes of death were obstetric haemorrhage (36.0%, <jats:italic>n<\/jats:italic>\u00a0=\u00a0359), hypertensive disorders of pregnancy (20.6%, <jats:italic>n<\/jats:italic>\u00a0=\u00a0206), sepsis (14.1%, <jats:italic>n<\/jats:italic>\u00a0=\u00a0141) and other (26.5%, <jats:italic>n<\/jats:italic>\u00a0=\u00a0264). Approximately a quarter of deaths occurred prior to delivery (28.4%, <jats:italic>n<\/jats:italic>\u00a0=\u00a0283), 35.7% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0356) occurred on the day of delivery and 35.9% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0359) occurred after delivery. Half of maternal deaths (50.6%; <jats:italic>n<\/jats:italic>\u00a0=\u00a0505) occurred in women aged 20\u201329\u00a0years, 10.3% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0103) occurred in women aged under 20\u00a0years, 34.5% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0344) occurred in women aged 30\u201339\u00a0years and 4.6% (<jats:italic>n<\/jats:italic>\u00a0=\u00a046) occurred in women aged \u226540\u00a0years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy\u2010related death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The large variation in the rate of pregnancy\u2010related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Inequality and inequity in pregnancy\u2010related death persists globally, irrespective of resource availability.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16309","type":"journal-article","created":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T06:08:16Z","timestamp":1588918096000},"page":"1082-1089","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Incidence and characteristics of pregnancy\u2010related death across ten low\u2010 and middle\u2010income geographical regions: secondary analysis of a cluster randomised controlled trial"],"prefix":"10.1111","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5216-8268","authenticated-orcid":false,"given":"N","family":"Vousden","sequence":"first","affiliation":[{"name":"Department of Women and Children's Health School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-7933","authenticated-orcid":false,"given":"PT","family":"Seed","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9081-7641","authenticated-orcid":false,"given":"MF","family":"Gidiri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology College of Health Sciences University of Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-7053","authenticated-orcid":false,"given":"S","family":"Goudar","sequence":"additional","affiliation":[{"name":"Women's and Children's Health Research Unit KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College Belgaum Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2000-743X","authenticated-orcid":false,"given":"J","family":"Sandall","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health 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