title: Maternal Mortality from Obstructed Labor: A MANDATE Analysis of the Ability of Technology to Save Lives in Sub-Saharan Africa.
abstract: Objective The aim of the study is to evaluate clinical interventions to significantly reduce maternal mortality from prolonged labor, obstructed labor, and prolonged obstructed labor (PL/OL/POL) in sub-Saharan Africa (SSA). Methods A mathematical model-Maternal and Neonatal Directed Assessment of Technology ("MANDATE")-was created for SSA with estimated prevalence for PL/OL/POL and case fatality rates from hemorrhage, infection, and uterine rupture. Based on a literature review and expert opinion, the model was populated with estimated likelihoods of the current healthcare system ability to diagnose, transfer, and treat women with these conditions. Impact on maternal mortality of improved diagnosis, transfer, and delivery to relieve PL/OL/POL was assessed. Results Without current technologies, the model estimated 8,464 maternal deaths annually in SSA from these conditions. Imputing current diagnosis, transfer, and treatment of PL/OL/POL, an estimated 7,033 maternal deaths occur annually from these complications. With improved PL/OL/POL diagnosis and improved transfer, 1,700 and 740 lives could be saved, respectively. Improved diagnosis, transfer, and treatment for PL/OL/POL reduce the mortality rate to 864 maternal deaths annually, saving 6,169 lives. If improved transfusion and antibiotic use were added, only 507 women per year would die from PL/OL/POL in SSA. Conclusion In SSA, increasing diagnostics, transfer to higher care, and operative delivery could substantially reduce maternal mortality from PL/OL/POL. Synopsis A computerized model of obstructed labor in SSA was created to explore the interventions necessary to reduce maternal mortality from this condition.
authors.affiliation: Department of Obstetrics/Gynecology, Columbia University, New York, New York.
authors.forename: Margo S
authors.initials: MS
authors.lastname: Harrison
authors.affiliation: RTI International, Durham, North Carolina.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Griffin
authors.affiliation: RTI International, Durham, North Carolina.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: RTI International, Durham, North Carolina.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Jones
authors.affiliation: RTI International, Durham, North Carolina.
authors.forename: Katelin
authors.initials: K
authors.lastname: Moran
authors.affiliation: Department of Obstetrics/Gynecology, Columbia University, New York, New York.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D008962:Models, Theoretical; D007744:Obstetric Labor Complications / Q000401:mortality*; D011247:Pregnancy