title: Direct patient interventions that can reduce maternal mortality in developing countries: a systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: Wichita State University, Wichita, KS.
authors.forename: Gina
authors.initials: G
authors.lastname: Brown
authors.forename: Lindsay
authors.initials: L
authors.lastname: Allen
authors.forename: Anne
authors.initials: A
authors.lastname: Torkelson
mesh_terms: D017610:Calcium Compounds / Q000008:administration & dosage; D002136:Calcium, Dietary / Q000008:administration & dosage*; D003906:Developing Countries; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000628:therapy*
chemical_list: D017610:Calcium Compounds; D002136:Calcium, Dietary