Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis

Research output: Contribution to journalArticlepeer-review

Standard

Anaesthesia-related maternal mortality in low-income and middle-income countries : a systematic review and meta-analysis. / Sobhy, Soha; Zamora, Javier; Dharmarajah, Kuhan; Arroyo-Manzano, David; Wilson, Matthew; Navaratnarajah, Ramesan; Coomarasamy, Arri; Khan, Khalid S; Thangaratinam, Shakila.

In: Lancet Global Health, Vol. 4, No. 5, 05.2016, p. e320-e327.

Research output: Contribution to journalArticlepeer-review

Harvard

APA

Vancouver

Author

Sobhy, Soha ; Zamora, Javier ; Dharmarajah, Kuhan ; Arroyo-Manzano, David ; Wilson, Matthew ; Navaratnarajah, Ramesan ; Coomarasamy, Arri ; Khan, Khalid S ; Thangaratinam, Shakila. / Anaesthesia-related maternal mortality in low-income and middle-income countries : a systematic review and meta-analysis. In: Lancet Global Health. 2016 ; Vol. 4, No. 5. pp. e320-e327.

Bibtex

@article{999edc89896f41a3b9ba36a1d10347c8,
title = "Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis",
abstract = "BACKGROUND: The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries.METHODS: In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805.FINDINGS: 44 studies (632 556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32 149 636 pregnancies and 36 144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths after caesarean section. Exposure to general anaesthesia increased the odds of maternal (odds ratio [OR] 3·3, 95% CI 1·2-9·0, I(2)=58%), and perinatal deaths (2·3, 1·2-4·1, I(2)=73%) compared with neuraxial anaesthesia. The rate of any maternal death was 9·8 per 1000 anaesthetics (5·2-15·7, I(2)=92%) when managed by non-physician anaesthetists compared with 5·2 per 1000 (0·9-12·6, I(2)=95%) when managed by physician anaesthetists.INTERPRETATION: The current international priority on strengthening health systems should address the risk factors such as general anaesthesia and rural setting for improving anaesthetic care in pregnant women.FUNDING: Ammalife Charity and ELLY Appeal, Bart's Charity.",
author = "Soha Sobhy and Javier Zamora and Kuhan Dharmarajah and David Arroyo-Manzano and Matthew Wilson and Ramesan Navaratnarajah and Arri Coomarasamy and Khan, {Khalid S} and Shakila Thangaratinam",
note = "Copyright {\textcopyright} 2016 Sobhy et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.",
year = "2016",
month = may,
doi = "10.1016/S2214-109X(16)30003-1",
language = "English",
volume = "4",
pages = "e320--e327",
journal = "Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier",
number = "5",

}

RIS

TY - JOUR

T1 - Anaesthesia-related maternal mortality in low-income and middle-income countries

T2 - a systematic review and meta-analysis

AU - Sobhy, Soha

AU - Zamora, Javier

AU - Dharmarajah, Kuhan

AU - Arroyo-Manzano, David

AU - Wilson, Matthew

AU - Navaratnarajah, Ramesan

AU - Coomarasamy, Arri

AU - Khan, Khalid S

AU - Thangaratinam, Shakila

N1 - Copyright © 2016 Sobhy et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

PY - 2016/5

Y1 - 2016/5

N2 - BACKGROUND: The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries.METHODS: In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805.FINDINGS: 44 studies (632 556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32 149 636 pregnancies and 36 144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths after caesarean section. Exposure to general anaesthesia increased the odds of maternal (odds ratio [OR] 3·3, 95% CI 1·2-9·0, I(2)=58%), and perinatal deaths (2·3, 1·2-4·1, I(2)=73%) compared with neuraxial anaesthesia. The rate of any maternal death was 9·8 per 1000 anaesthetics (5·2-15·7, I(2)=92%) when managed by non-physician anaesthetists compared with 5·2 per 1000 (0·9-12·6, I(2)=95%) when managed by physician anaesthetists.INTERPRETATION: The current international priority on strengthening health systems should address the risk factors such as general anaesthesia and rural setting for improving anaesthetic care in pregnant women.FUNDING: Ammalife Charity and ELLY Appeal, Bart's Charity.

AB - BACKGROUND: The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries.METHODS: In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805.FINDINGS: 44 studies (632 556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32 149 636 pregnancies and 36 144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths after caesarean section. Exposure to general anaesthesia increased the odds of maternal (odds ratio [OR] 3·3, 95% CI 1·2-9·0, I(2)=58%), and perinatal deaths (2·3, 1·2-4·1, I(2)=73%) compared with neuraxial anaesthesia. The rate of any maternal death was 9·8 per 1000 anaesthetics (5·2-15·7, I(2)=92%) when managed by non-physician anaesthetists compared with 5·2 per 1000 (0·9-12·6, I(2)=95%) when managed by physician anaesthetists.INTERPRETATION: The current international priority on strengthening health systems should address the risk factors such as general anaesthesia and rural setting for improving anaesthetic care in pregnant women.FUNDING: Ammalife Charity and ELLY Appeal, Bart's Charity.

U2 - 10.1016/S2214-109X(16)30003-1

DO - 10.1016/S2214-109X(16)30003-1

M3 - Article

C2 - 27102195

VL - 4

SP - e320-e327

JO - Lancet Global Health

JF - Lancet Global Health

SN - 2214-109X

IS - 5

ER -