Evidence-based interventions being done to reduce maternal mortality and morbidity across the world and in India: A Systematic Review
DOI:
https://doi.org/10.47203/IJCH.2026.v38i01.003Keywords:
Evidence-based, Hypertension, Intervention, Evidence-based, Hypertension, Intervention, Maternal Mortality, Morbidity, Morbidity patternsAbstract
Background: Maternal mortality remains a global concern, with 260,000 women dying in 2023 due to pregnancy-related causes. The majority of deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa and South East Asia. While preventable, almost 700 women died daily from preventable causes related to pregnancy and childbirth in 2023. Aim: This article aims to review evidence-based interventions at both the community and clinical levels that have effectively reduced maternal mortality and morbidity globally, focusing on India. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Inclusion criteria encompassed randomized controlled trials (RCTs) published in English from 2003 to 2023, focusing on interventions specifying types and durations. Exclusion criteria included unclear interventions, success reports over 20 years old, and interventions with more than 2 arms. Result: Among 26 selected clinical trials, diverse objectives, methods, and participant characteristics hindered formal meta-analysis. Most trials focused on hospital-based interventions, with pharmacological and non-pharmacological interventions showing efficacy. Risk of bias analysis revealed common uncertainties and challenges, particularly in blinding and participant/investigator accessors. Interventions to reduce maternal mortality and morbidity: Trials assessed pharmacological interventions such as Tranexamic acid, Misoprostol, Carbetocin, and others, alongside non-pharmacological interventions like uterine massage and nutritional management. While most interventions were effective, some studies reported non-significant differences. Risk of bias was present, emphasizing the need for rigorous methodologies. Conclusion: The review underscores the success of interventions in reducing maternal mortality and morbidity globally, with most trials conducted in low- and middle-income countries. Findings highlight the effectiveness of various interventions, from drugs like Tranexamic acid to community-based initiatives. The results suggest the feasibility of reducing maternal mortality by identifying underlying factors and implementing evidence-based interventions, emphasizing the importance of both clinical and community-level approaches.
Downloads
References
World Health Organization. Maternal mortality [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal [Internet]. 2014 [cited 2026 Dec 10];2:e323–33. Available from: www.thelancet.com/
Callaghan WM, Creanga AA, Kuklina E V. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5):1029–36.
Health - United Nations Sustainable Development [Internet]. [cited 2025 Dec 10]. Available from: https://www.un.org/sustainabledevelopment/health/
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009;6(7).
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane [Internet]. 2023; Available from: https://training.cochrane.org/handbook
Oseni RO, Zakari M, Adamou N, Umar UA. Effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano teaching hospital, Kano: A randomized controlled trial. Pan Afr Med J. 2021 May;39.
Nargis N, Dewan F. Prophylactic use of Tranexamic Acid during Caesarean Section in Preventing Postpartum haemorrhage– a Prospective Randomised Double Blind Placebo Controlled Study. Bangladesh J Obstet Gynaecol. 2018 Jul;33(2):125–30.
Dhivya Lakshmi SJ, Abraham R. Role of prophylactic tranexamic acid in reducing blood loss during elective caesarean section: A randomized controlled study. J Clin Diagnostic Res. 2016 Dec;10(12):OC17–21.
Ali MM, El-Bromboly WH, Elnagar WM, Abou Hashem MF. Prevention of postpartum hemorrhage after vaginal delivery using tranexamic acid. The Egyptian Journal of Hospital Medicine. 2021 Oct 1;85(1):2937-40.
Ducloy-Bouthors AS, Jude B, Duhamel A, Broisin F, Huissoud C, Keita-Meyer H, et al. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care. 2011 Apr;15(2).
Zgaya R, Ghadhab I, Triki MA, Briki R. Randomized controlled trial comparing 400μg sublingual misoprostol versus placebo for prevention of primary postpartum hemorrhage. Pan Afr Med J. 2020 May;36:1–9.
Tewatia R, Rani S, Srivastav U, Makhija B. Sublingual misoprostol versus intravenous oxytocin in prevention of post-partum hemorrhage. Arch Gynecol Obstet. 2014 Apr;289(4):739–42.
Akpan U, Asibong U, Arogundade K, Akpanika C, Ekott M, Etuk S. Effectiveness of pre-operative rectal misoprostol in reducing blood loss during cesarean section for placenta previa and manual removal of retained placenta: A parallel placebo-controlled study. Open Access Maced J Med Sci. 2021;9(B):161–6.
Atukunda EC, Siedner MJ, Obua C, Mugyenyi GR, Twagirumukiza M, Agaba AG. Sublingual Misoprostol versus Intramuscular Oxytocin for Prevention of Postpartum Hemorrhage in Uganda: A Double-Blind Randomized Non-Inferiority Trial. PLoS Med. 2014;11(11).
Ghafoor S, Sara B, Sadiq F. Comparison the Effectiveness of Oxytocin and Misoprostol in Prevention of Primary Post-Partum Haemorrhage. Pakistan J Med Heal Sci. 2022 Sep;16(9):778–80.
Nahaer MK, Nurunnobi AKM, Talukder SI, Ferdousy H, Sharmin F, Islam GMR, et al. Carbetocin Versus Oxytocin for Prophylaxis of PPH Used During Caesarean Section: An Open Label Randomized Control Trial. Bangladesh J Obstet Gynaecol. 2018 Jul;33(2):113–8.
Salem MAA, Saraya YS, Badr MS, Soliman AZM. Intra-umbilical vein injection of carbetocin versus oxytocin in the management of retained placenta. Sex Reprod Healthc. 2019 Oct;21:21–5.
Yesmin S, Begum F, Bain S, Tareq AHMI, Parvin S, Jahan FI, et al. Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section. Bangladesh J Obstet Gynaecol. 2020;35(2):63–7.
Samimi M, Imani-Harsini A, Abedzadeh-Kalahroudi M. Carbetocin vs. syntometrine in prevention of postpartum hemorrhage: A double blind randomized control trial. Iran Red Crescent Med J. 2013;15(9):817–22.
Alalfy M, Hussein E, Saber W, Elsharkawy M, Salama S, Lasheen Y, et al. Alalfy modified cervical inversion technique as a tamponade in controlling PPH in placenta previa, a multicentric double blind randomized controlled trial. J Matern Neonatal Med. 2021;34(19):3162–8.
Suhrabi Z, Akbari M, Taghinejad H, Azami G. Comparing the Effect of Dextrose and Oxytocin to Reduce Postpartum Haemorrhage: Randomised Controlled Trial. J Clin DIAGNOSTIC Res. 2019;
Suhrabi Z, Taghinejad H, Direkvand-Moghadam A, Akbari M. The effect of oxygen inhalation plus oxytocin compared with oxytocin only on postpartum haemorrhage: A randomized clinical trial. J Clin Diagnostic Res. 2016 Sep;10(9):QC01–3.
Erkaya R, Karabulutlu Ö, Çalik KY. Uterine massage to reduce blood loss after vaginal delivery. Health Care Women Int. 2021;
Lei B, Guo M, Deng X, He S, Lu X, Wang Y, et al. Intraoperative cell salvage as an effective intervention for postpartum hemorrhage—Evidence from a prospective randomized controlled trial. Front Immunol. 2022 Oct;13.
Jago AA, Ezechi OC, Achinge GI, Okunlola MA. Effect of oxytocics on the blood pressure of normotensive Nigerian parturients. J Matern Neonatal Med. 2007;20(9):703–5.
Begum B, Akhter N, Uddin MK, Aziz MA, Nova KK. Fluid and nutritional management can significantly reduce the mortality of patients with eclampsia in resource poor settings. Bangladesh J Obstet Gynecol. 2012;27(1):18–20.
Duley L, Farrell B, Armstrong N, Spark P, Roberts B, Smyth R, et al. The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years. BJOG An Int J Obstet Gynaecol. 2007 Mar;114(3):300–9.
Sevene E, Sharma S, Munguambe K, Sacoor C, Vala A, Macuacua S, et al. Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertens. 2020 Jul;21:96–105.
Vousden N, Lawley E, Nathan HL, Seed PT, Gidiri MF, Goudar S, et al. Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet Glob Heal. 2019 Mar;7(3):e347–56.
Anger HA, Dabash R, Durocher J, Hassanein N, Ononge S, Frye LJ, et al. The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum haemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomised trial. BJOG An Int J Obstet Gynaecol. 2019 Dec;126(13):1612–21.
Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. New England Journal of Medicine. 2005 May 19;352(20):2091-9.
Evensen A, Anderson JM, Fontaine P. Postpartum hemorrhage: prevention and treatment. American family physician. 2017 Apr 1;95(7):442-9.
Widmer M. Updated WHO PPH recommendations PPH Community of Practice Annual Meeting.
Downloads
Published
How to Cite
License
Copyright (c) 2026 Yogesh Bahurupi, Pushpendra Kaushik, Ravleen Kaur Bakshi, Puneet Misra, Mahendra Singh, Nandita Sharma, Aditya Choudhary, Shantam Pokhriyal, Om Prakash Bera, Meenu Singh, Pradeep Aggarwal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
