{
    "abstract": "Despite strong evidence-based strategies for prevention and management, global efforts to reduce deaths from postpartum haemorrhage (PPH) have failed, and it remains the leading cause of maternal mortality. We conducted a detailed review of all maternal deaths from 33 facilities in Malawi to identify health system weaknesses leading to deaths from PPH.\nData were collected regarding every maternal death occurring across all district and central hospitals in Malawi. Deaths occurring from August 2020 to December 2022 were reviewed by multidisciplinary facility-based teams who compiled case narratives from clinical notes and then subsequently reviewed by obstetricians to confirm the cause of death according to international criteria. Data were summarised using proportions/frequencies, comparisons made using \u03c7\nPPH was the cause of 20.4% of maternal deaths. Most deaths from PPH occurred within 24 hours of birth (80.0%), among women who had been referred to a higher-level facility (57.0%) and were admitted in stable condition (60.0%). Vacuum births carried an increased risk of death from PPH (OR 4.25 (95% CI 1.15 to 20.13, p=0.039)). Detailed reviews identified that deaths from PPH were more likely to be associated with factors such as 'lack of obstetric lifesaving skills' (26.7% vs 10.1%, p<0.001), 'inadequate monitoring' (51.5% vs 40.7%, p=0.012) and 'communication problems between facilities' (11.5% vs 6.2%, p=0.019) than deaths from other causes.\nOur analysis represents the largest published review of maternal deaths from PPH. We demonstrate that key health system weaknesses are contributing to these preventable maternal deaths. Case reviews conducted by multidisciplinary facility-based teams identified common and recurrent avoidable factors associated with deaths from PPH. Global efforts must now be focused on strategies that address these weaknesses, strengthening health systems and empowering healthcare workers to reduce maternal deaths from PPH.",
    "authors": [
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK jennifer.riches@liverpool.ac.uk.\nMaternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Jennifer",
            "initials": "J",
            "lastname": "Riches"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.",
            "firstname": "James",
            "initials": "J",
            "lastname": "Jafali"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.\nMaternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Hussein H",
            "initials": "HH",
            "lastname": "Twabi"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.\nMaternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Yamikani",
            "initials": "Y",
            "lastname": "Chimwaza"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Marthe",
            "initials": "M",
            "lastname": "Onrust"
        },
        {
            "affiliation": "Reproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Malawi.",
            "firstname": "Rosemary",
            "initials": "R",
            "lastname": "Bilesi"
        },
        {
            "affiliation": "Kamuzu University of Health Sciences, Blantyre, Malawi.",
            "firstname": "Luis",
            "initials": "L",
            "lastname": "Gadama"
        },
        {
            "affiliation": "Reproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Malawi.",
            "firstname": "Fannie",
            "initials": "F",
            "lastname": "Kachale"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Annie",
            "initials": "A",
            "lastname": "Kuyere"
        },
        {
            "affiliation": "Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Lumbani",
            "initials": "L",
            "lastname": "Makhaza"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Regina",
            "initials": "R",
            "lastname": "Makuluni"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Laura",
            "initials": "L",
            "lastname": "Munthali"
        },
        {
            "affiliation": "Reproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Malawi.",
            "firstname": "Owen",
            "initials": "O",
            "lastname": "Musopole"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Chifundo",
            "initials": "C",
            "lastname": "Ndamala"
        },
        {
            "affiliation": "Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "Deborah A",
            "initials": "DA",
            "lastname": "Phiri"
        },
        {
            "affiliation": "Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.",
            "firstname": "Arri",
            "initials": "A",
            "lastname": "Coomarasamy"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.",
            "firstname": "Abi",
            "initials": "A",
            "lastname": "Merriel"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.\nInfectious Diseases Institute, Makerere University, Kampala, Uganda.",
            "firstname": "Catriona",
            "initials": "C",
            "lastname": "Waitt"
        },
        {
            "affiliation": "Maternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.\nDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.",
            "firstname": "Maria Lisa",
            "initials": "ML",
            "lastname": "Odland"
        },
        {
            "affiliation": "Women's and Children's Health, University of Liverpool, Liverpool, UK.\nMaternal and Fetal Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.",
            "firstname": "David",
            "initials": "D",
            "lastname": "Lissauer"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",
    "doi": "10.1136/bmjgh-2024-015781\n10.1016/S2214-109X(14)70227-X\n10.1002/14651858.CD007872.pub3\n10.1002/14651858.CD001808.pub3\n10.1002/14651858.CD011689.pub2\n10.1056/NEJMoa1805489\n10.1371/journal.pone.0041114\n10.1016/S2214-109X(22)00359-X\n10.1371/journal.pone.0217853\n10.1186/s13012-022-01253-0\n10.1186/s12884-021-03801-w\n10.1056/NEJMoa2303966",
    "journal": "BMJ global health",
    "keywords": [
        "Epidemiology",
        "Global Health",
        "Health systems",
        "Maternal health",
        "Obstetrics"
    ],
    "methods": null,
    "publication_date": "2025-01-10",
    "pubmed_id": "39788754\n25103301\n26079202\n31032882\n23586122\n29693726\n29949473\n22844432\n36155136\n27733286\n31185020\n36631821\n33888075\n37158447",
    "results": "PPH was the cause of 20.4% of maternal deaths. Most deaths from PPH occurred within 24 hours of birth (80.0%), among women who had been referred to a higher-level facility (57.0%) and were admitted in stable condition (60.0%). Vacuum births carried an increased risk of death from PPH (OR 4.25 (95% CI 1.15 to 20.13, p=0.039)). Detailed reviews identified that deaths from PPH were more likely to be associated with factors such as 'lack of obstetric lifesaving skills' (26.7% vs 10.1%, p<0.001), 'inadequate monitoring' (51.5% vs 40.7%, p=0.012) and 'communication problems between facilities' (11.5% vs 6.2%, p=0.019) than deaths from other causes.",
    "title": "Avoidable factors associated with maternal death from postpartum haemorrhage: a national Malawian surveillance study.",
    "xml": "<Element 'PubmedArticle' at 0x788505d26520>"
}