• Logo
  • SBMUJournals

Causes of Maternal Mortality in Tehran, Iran

Abdolrazagh Barzegar, Mohammadjavad Hedayatshodeh, Mehdi Forouzesh, Masoud Ghadipasha, Pardis Shojaei, Fardin Fallah




Maternal mortality is a woman’s death during pregnancy or postpartum period due to direct or indirect causes. Its direct causes are related to obstetrical issues. The indirect cause of it refer to an underlying disease, i.e. aggravated during pregnancy and leads to death. A routine data-based study conducted at the Legal Medicine Organization of Tehran City, Iran, the autopsy findings of maternal mortalities during April 2017-2019 were reviewed. During the study period, 53 cases were autopsied of which 29 (54.7%) and 24 (45.3%) died due to direct and indirect causes, respectively. , The prevalent direct causes of death, were bleeding (22.6%), eclampsia/preeclampsia (13.2%), and ectopic pregnancy (5.7%). Frequent indirect causes were cardiac diseases (20.7%) and nervous system and infectious diseases (both: 7.5%). This study revealed the considerable share of indirect causes in maternal mortalities in Tehran. Moreover, we outlined the importance of early detection of non-obstetrical medical conditions during pregnancy care to reduce preventable maternal mortalities.


Autopsy, Cause of death, Maternal mortality


‎1.‎ Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal ‎mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality ‎Estimation Inter-Agency Group. Lancet. 2016; 387(10017):462-74. [DOI:10.1016/S0140-6736(15)00838-7]‎

‎2.‎ Keskin HL, Engin Üstün Y, Sanisoğlu S, Karaahmetoğlu S, Özcan A, Çelen Ş, et al. The value of autopsy to determine the cause of ‎maternal deaths in Turkey. Journal of the Turkish German Gynecological Association. 2018; 19(4):210-4. ‎‎[DOI:10.4274/jtgga.2018.0082] [PMCID]‎

‎3.‎ WHO, UNICEF, UNFPA, World Bank Group, United Nations Population Division. Trends in maternal mortality: 1990 to 2015: ‎Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health ‎Organization; 2015.‎

‎4.‎ Sadoughi F, Karimi A, Erfannia L. Information management in Iranian maternal mortality surveillance system. Electron Physician. ‎‎2017; 9(7):4914-23. [DOI:10.19082/4914] [PMID] [PMCID]‎

‎5.‎ American College of Obstetricians and Gynecologists. ACOG Committee Opinion No 579: Definition of term pregnancy. Obstetrics ‎& Gynecology. 2013; 122(5):1139-40. [DOI:10.1097/01.AOG.0000437385.88715.4a] [PMID]‎

‎6.‎ Zalvand R, Tajvar M, Pourreza A, Asheghi H. Determinants and causes of maternal mortality in Iran based on ICD-MM: A ‎systematic review. Reproductive Health. 2019; 16(1):1-15. [DOI:10.1186/s12978-019-0676-y] [PMID] [PMCID]‎

‎7.‎ Vahiddastjerdy M, Changizi N, Habibollahi A, Janani L, Farahani Z, Babaee F. Maternal mortality ratio and causes of death in IRI ‎between 2009 and 2012. Journal of Family & Reproductive Health. 2016; 10(3):154-62. [PMID] [PMCID]‎

‎8.‎ Cirelli JF, Surita FG, Costa ML, Parpinelli MA, Haddad SM, Cecatti JG. The burden of indirect causes of maternal morbidity and ‎mortality in the process of obstetric transition: A cross-sectional multicenter study. Revista Brasileira Ginecol Obstet. 2018; ‎‎40(3):106-14. [DOI:10.1055/s-0038-1623511] [PMID]‎

‎9.‎ Dadipoor S, Mehraban M, Ziapour A, Safari-Moradabadi A. Causes of maternal mortality in Iran: A systematic review. ‎International Journal of Pediatrics. 2017; 5(12):6757-70. [DOI: 10.22038/IJP.2017.26983.2325]‎

‎10.‎ Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. ‎The Lancet Global Health. 2014; 2(6):e323-33. [DOI:10.1016/S2214-109X(14)70227-X]‎

‎11.‎ Rabiu KA, Adewunmi AA, Ottun TA, Akinlusi FM, Adebanjo AA, Alausa TG. Risk factors for maternal mortality associated with ‎eclampsia presenting at a Nigerian tertiary hospital. International Journal of Women’s Health. 2018; 10:715-21. ‎‎[DOI:10.2147/IJWH.S178729] [PMID] [PMCID]‎

‎12.‎ Lisonkova S, Tan J, Wen Q, Abdellatif L, Richter LL, Alfaraj S, et al. Temporal trends in severe morbidity and mortality associated ‎with ectopic pregnancy requiring hospitalisation in Washington State, USA: A population-based study. BMJ Open. 2019; ‎‎9(2):e024353. [DOI:10.1136/bmjopen-2018-024353] [PMID] [PMCID]‎

‎13.‎ Taghizadeh Z, Pourbakhtiar M, Azimi K, Ghadipasha M, Soltani K. Claims about medical malpractices resulting in neonatal and ‎maternal impairment in Iran. Journal of Forensic and Legal Medicine. 2019; 66:44-49. [DOI:10.1016/j.jflm.2019.06.008] [PMID]‎

‎14.‎ Mocumbi AO, Sliwa K, Soma-Pillay P. Medical disease as a cause of maternal mortality: The pre-imminence of cardiovascular ‎pathology. Cardiovascular Journal of Africa. 2016; 27(2):84-8. [DOI:10.5830/CVJA-2016-018] [PMID] [PMCID]‎

‎15.‎ Nair M, Nelson-Piercy C, Knight M. Indirect maternal deaths: UK and global perspectives. Obstetric Medicine. 2017; 10(1):10-15. ‎‎[DOI:10.1177/1753495X16689444] [PMID] [PMCID]‎

DOI: https://doi.org/10.32598/ijmtfm.v9i4.26647