Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.

<bold>Objective: </bold>The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources.<bold>Design: </bold>This is a secondary analysis of a stepped-wedge cluster randomised controlled trial.<bold>Setting: </bold>This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti.<bold>Population: </bold>Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion.<bold>Methods: </bold>Pregnancy-related deaths were collected prospectively from routine data sources and active case searching.<bold>Main Outcome Measures: </bold>Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome.<bold>Results: </bold>Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death.<bold>Conclusions: </bold>The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists.<bold>Tweetable Abstract: </bold>Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability. [ABSTRACT FROM AUTHOR]