{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T17:25:05Z","timestamp":1769793905251,"version":"3.49.0"},"reference-count":42,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine differences in cause\u2010of\u2010maternal\u2010death assignment based on underlying versus multiple causes of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional, population\u2010based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>United States, 1999\u20132002 and 2018\u20132022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>1633 maternal deaths in 1999\u20132002 and 1929 maternal deaths in 2018\u20132022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Causes of death were identified based on the underlying cause of death and also based on multiple causes of death. The frequency of six selected obstetrical causes of death was quantified and ranked.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pre\u2010eclampsia (0.87 per 100\u2009000 live births, 95% confidence interval [CI] 0.74\u20131.02) was the most common cause of maternal death in 2018\u20132022, when cause\u2010of\u2010death assignment was based on the underlying cause of death. Amniotic fluid embolism and cardiomyopathy tied for second rank, haemorrhage placed fourth and puerperal sepsis and uterine rupture tied for the fifth rank. Rankings based on multiple causes of death showed a different pattern: haemorrhage (1.13 per 100\u2009000 live births, 95% CI 0.98\u20131.29) was the most common cause, followed by pre\u2010eclampsia, cardiomyopathy, amniotic fluid embolism, puerperal sepsis and uterine rupture. There was no significant correlation between the cause\u2010of\u2010maternal death rankings based on the underlying and multiple causes of death (correlation coefficient 0.62, 95% CI\u20100.39, 0.95;\n                      <jats:italic>p<\/jats:italic>\n                      value 0.19) in 2018\u20132022. Cause\u2010of\u2010death rankings were significantly correlated under the two methods of cause\u2010of\u2010death assignment in 1999\u20132002 (correlation coefficient 0.83, 95% CI 0.05, 0.98;\n                      <jats:italic>p<\/jats:italic>\n                      value 0.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Basing cause\u2010of\u2010death assignment and ranking of the causes of maternal death using a multiple causes\u2010of\u2010death approach may better inform clinical and public health priorities for reducing maternal mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18298","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T13:58:53Z","timestamp":1753711133000},"page":"1689-1696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Traditional Versus Contemporary Models for Identifying Causes of Maternal Death: A Population\u2010Based Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9096-7439","authenticated-orcid":false,"given":"Yasser","family":"Sabr","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"},{"name":"Department of Obstetrics and Gynaecology College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarka","family":"Lisonkova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"},{"name":"School of Population and Public Health, University of British Columbia Vancouver  British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Am\u00e9lie","family":"Boutin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine, Universit\u00e9 Laval and CHU de Qu\u00e9bec\u2010Universit\u00e9 Laval Research Center  Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chantal","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K. S.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"},{"name":"School of Population and Public Health, University of British Columbia Vancouver  British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","year":"2023"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"e_1_2_11_4_1","first-page":"301","article-title":"Maternal Mortality and the Impact of Healthcare Policy","volume":"7","author":"Walden R.","year":"2018","journal-title":"International Journal of Health Policy and Management"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.12.038"},{"key":"e_1_2_11_6_1","article-title":"Despite New Manuscript, Incontrovertible Evidence Proves the Unacceptably High U.S. Maternal Mortality Rate","author":"ACOG News Release","year":"2024","journal-title":"American College of Obstetricians and Gynecologists"},{"key":"e_1_2_11_7_1","article-title":"The Maternal\u2010Mortality Crisis That Didn't Happen","author":"Demsas J.","year":"2024","journal-title":"Atlantica"},{"key":"e_1_2_11_8_1","unstructured":"C.GomezandT.Carman \u201cCanada Significantly Undercounts Maternal Deaths and Doctors are Sounding the Alarm. 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