Direct patient interventions that can reduce maternal mortality in developing countries: a systematic review.

BACKGROUND AND OBJECTIVES Maternal mortality is a major concern in developing countries. This study identified and evaluated specific direct patient interventions made in developing countries that could result in a decrease of the maternal mortality rate. METHODS A systematic review of articles from Cochrane Library and MEDLINE databases was conducted. Articles chosen for review focused on small, practical, clinical interventions, while large, program, or government policy-based interventions were excluded. RESULTS Sixty-eight articles were reviewed, and nine were selected for evaluation. Calcium supplementation during pregnancy had a maternal mortality relative risk of 0.80 (95% CI=0.70--0.91). Women with an interpregnancy interval of 18 to 24 months have a significantly lower risk of complications, while shorter and longer interpregnancy intervals were associated with an increase in maternal adverse outcomes or maternal death (adjusted odds ratio 2.54; 95% CI 1.22-5.38). Active management of the third stage of labor, specifically the use of uterotonic agents, decreased a woman's risk of postpartum hemorrhage, which is the leading cause of maternal mortality in most developing countries. CONCLUSIONS The use of calcium supplementation to decrease maternal mortality is beneficial with a Grade A Recommendation. Educating women to space pregnancies according to lowest risk times is given a Grade D Recommendation. Using uterotonics as active management of the third stage of labor is given a Grade B Recommendation. These simple implementations can potentially save many lives, especially in remote areas and areas of low resource.