Generic placeholder image



ISSN (Print): 2666-7967
ISSN (Online): 2666-7975

Research Article

Examining the Causes of Maternal Mortality in Pregnant Women Since the Beginning of the COVID-19 Pandemic in Hamadan Province, Western Iran: A Research Article

Author(s): Samereh Ghelichkhani, Fariba Keramat, Ebrahim Jalili, Faezeh Moshayedi, Seyedeh Zahra Masoumi*, Azam Ali Shirzadeh, Mostafa Eghbalian, Venus Hajialiakbari and Fatemeh Shahbazi

Volume 3, Issue 5, 2022

Published on: 19 September, 2022

Article ID: e180822207643 Pages: 10

DOI: 10.2174/2666796703666220818141551


Background: Maternal mortality prevention and delivering optimal outcomes for both mother and fetus is the utmost concern of health systems in any country.

Objective: This study aimed to examine maternal mortality in pregnant women since the beginning of the COVID-19 pandemic in Hamadan province, western Iran. Examining the causes of maternal mortality can be valuable in identifying mortality factors in line with prospective strategic plans.

Methods: This case series study introduces the data of seven deceased pregnant women, the deaths of whom occurred since the beginning of the COVID-19 pandemic (December 2019 – March 2021) in the hospitals of cities within Hamadan province. All data were reported at the time of death or at least 14 days after hospital admission. In this study, epidemiological features and pregnancy history, background diseases, clinical symptoms, initial vital signs, medications in use, clinical laboratory values, delivery type, and neonatal outcome were assessed, respectively.

Results: In the seven maternal mortality cases reported in this study, three women succumbed to pregnancy- related causes (two cases of preeclampsia and one case of antiphospholipid syndrome), and four women to severe coronavirus disease. All deceased mothers had been admitted to the intensive care unit as a result of severe illness. Four cases concerned a background condition as well, which included thromboembolic disorders, epilepsy, and lupus. In mortality cases, two women displayed a BMI score over 30. One maternal death had occurred 42 days postpartum, while five deaths had occurred prior to 37 weeks of gestation, and one past 37 weeks of gestation.

Conclusion: This report provided valuable information on maternal mortality factors. Maternal mortality necessitates a careful acquisition of monitoring data, but in the prevailing pandemic circumstances, caution necessitates raising awareness of the maternal mortality potential in women with COVID-19 diagnosis in the second or third trimester. Pregnancy care programs must focus on recognizing high-risk groups of mothers-to-be with background conditions and risk factors for pregnancy, given that early diagnosis and prompt referral are invaluable in the immediate treatment and relief of pregnant mothers-to-be.

Keywords: Eclampsia, mortality, preeclampsia, pregnancy, COVID-19, pandemic.

Graphical Abstract
WHO. Coronavirus disease (COVID-19): Pregnancy and childbirth. 2020. Available from:,244
Howell EA, Zeitlin J, Hebert PL, Balbierz A, Egorova N. Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity. JAMA 2014; 312(15): 1531-41.
[] [PMID: 25321908]
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal health study group of the canadian perinatal surveillance system. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176(4): 455-60.
[] [PMID: 17296957]
Kozic JR, Benton SJ, Hutcheon JA, Payne BA, Magee LA, von Dadelszen P. PIERS (preeclampsia integrated estimate of risk) study group. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Can 2011; 33(10): 995-1004.
[] [PMID: 22014776]
Zolala F, Heidari F, Afshar N, Haghdoost AA. Exploring maternal mortality in relation to socioeconomic factors in Iran. Singapore Med J 2012; 53(10): 684-9.
[PMID: 23112022]
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020; 323(11): 1061-9.
[] [PMID: 32031570]
Alserehi H, Wali G, Alshukairi A, Alraddadi B. Impact of Middle East respiratory syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis 2016; 16(1): 105.
[] [PMID: 26936356]
Dadipoor S, Mehraban M, Ziapour A, Safari-Moradabadi A. Causes of maternal mortality in Iran: A systematic review. Int J Pediatr 2017; 5(12): 6757-5770.
Khan S, Siddique R, Hao X, et al. The COVID-19 infection in children and its association with the immune system, prenatal stress, and neurological complications. Int J Biol Sci 2022; 18(2): 707-16.
[] [PMID: 35002519]
Wastnedge EAN, Reynolds RM, van Boeckel SR, et al. Pregnancy and COVID-19. Physiol Rev 2021; 101(1): 303-18.
[] [PMID: 32969772]
Galvão LPL, Alvim-Pereira F, de Mendonça CMM, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth 2014; 14(1): 25.
[] [PMID: 24433516]
Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet 2020; 395(10226): 760-2.
[] [PMID: 32151334]
Ríos-Silva M, Murillo-Zamora E, Mendoza-Cano O, Trujillo X, Huerta M. COVID-19 mortality among pregnant women in Mexico: A retrospective cohort study. J Glob Health 2020; 10(2): 020512.
[] [PMID: 33110595]
MD, FGG Williams Obstetrics. (25th ed.), MC Graw-Hill Education Medical : NY 2018.
Mawarti Y, Utarini A, Hakimi M. Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: A retrospective cohort study. BMC Pregnancy Childbirth 2017; 17(1): 149-9.
[] [PMID: 28532393]
Mullins E, Evans D, Viner RM, O’Brien P, Morris E. Coronavirus in pregnancy and delivery: Rapid review. Ultrasound Obstet Gynecol 2020; 55(5): 586-92.
[] [PMID: 32180292]
Georgopoulou S, Efraimidou S, MacLennan SJ, Ibrahim F, Cox T. Antiphospholipid (Hughes) syndrome: Description of population and health-related quality of life (HRQoL) using the SF-36. Lupus 2015; 24(2): 174-9.
[] [PMID: 25239925]
Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID multinational cohort study. JAMA Pediatr 2021; 175(8): 817-26.
[] [PMID: 33885740]
Uthman I, Noureldine MHA, Ruiz-Irastorza G, Khamashta M. Management of antiphospholipid syndrome. Ann Rheum Dis 2019; 78(2): 155-61.
[] [PMID: 30282668]
Nayak AH, Kapote DS, Fonseca M, et al. Impact of the coronavirus infection in pregnancy: A preliminary study of 141 patients. J Obstet Gynaecol 2020; 70(4): 256-61.

© 2024 Bentham Science Publishers | Privacy Policy