Gebili Shaimaa Abdallah, Hekal Norhan Hassan, Elsawy Neamat Hamdy, Beltagy Esraa Morshedy, Kandil Walaa Mohamed, Hassanin Ebtisam, Gamaleldin Hatem, Tolbah Mahmoud M, Abady Ahmed Mohamed, Ghazy Ramy Mohamed
Head of Clinical Research Department of Fayoum Government, Ministry of Health and Population, Cairo, Egypt.
Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Sci Rep. 2025 Aug 30;15(1):31944. doi: 10.1038/s41598-025-15818-8.
This study aimed to identify the characteristics and predictors of coronavirus disease (COVID-19)-related maternal deaths in 2020 and 2021, and to assess maternal mortality ratio (MMR) from 2018 to 2021 in Egypt. A record-based cross-sectional analytical study was conducted in four randomly selected governorates: Kafr El-Sheikh, El-Behira, (Lower Egypt) and Assiut, and Fayoum (Upper Egypt). Data from 541 maternal deaths were analyzed, revealing that 37.7% occurred in Assuit, 28.5% in El-Behira, 22.7% in Fayoum, and 11.1% in Kafr El-Sheik. The mean age of the studied population was 28.9 ± 6.4 years, with 39.0% having 1-2 children and 26.8% being nulliparous. Direct causes, including postpartum haemorrhage, preeclampsia, and embolism, accounted for 47.5% of deaths. As one of indirect causes of deaths, COVID-19 was diagnosed in 25.3%, it was the sole cause in 75.0% of them. Multivariable analysis identified the year 2021 (adjusted odds ratio (aOR) = 3.32; 95% CI, 1.9-5.81), residence in Lower Egypt (aOR = 5.15; 95% CI, 2.61-10.18), and hospital referral refusals (aOR = 8.72; 95% CI, 1.73-44.0) as key predictors of COVID-19-associated MM. The overall MMR increased between 2018 and 2021 with significant increases observed in Fayoum (from 39.25 to 71.65; p < 0.001) and Kafr El-Sheikh (from 36.44 to 56.6; p = 0.032). Yearly comparisons revealed significant inter-governorate differences in all years except 2021 (p = 0.15), with Assuit maintaining the highest MMR. Although the national MMR increased from 44.1 (pre-COVID-19) to 55.9 (post-COVID-19), this change was not statistically significant (p = 0.236). The findings highlight an alarming rise in maternal deaths and underscore the need for targeted interventions to address the direct causes of MM and improve healthcare access during crises like the COVID-19 pandemic.
本研究旨在确定2020年和2021年与冠状病毒病（COVID-19）相关的孕产妇死亡的特征和预测因素，并评估埃及2018年至2021年的孕产妇死亡率（MMR）。在随机选择的四个省份进行了一项基于记录的横断面分析研究：卡夫尔谢赫、贝希拉（下埃及）、阿斯尤特和法尤姆（上埃及）。对541例孕产妇死亡数据进行了分析，结果显示，37.7%的死亡发生在阿斯尤特，28.5%在贝希拉，22.7%在法尤姆，11.1%在卡夫尔谢赫。研究人群的平均年龄为28.9±6.4岁，39.0%育有1-2个孩子，26.8%为未生育过的妇女。包括产后出血、先兆子痫和栓塞在内的直接死因占死亡人数的47.5%。作为死亡的间接原因之一，25.3%的病例被诊断为COVID-19，其中75.0%的病例中COVID-19是唯一死因。多变量分析确定2021年（调整优势比（aOR）=3.32；95%置信区间，1.9-5.81）、居住在下埃及（aOR=5.15；95%置信区间，2.61-10.18）以及拒绝转诊至医院（aOR=8.72；95%置信区间，1.73-44.0）是与COVID-19相关的孕产妇死亡的关键预测因素。2018年至2021年期间，总体孕产妇死亡率有所上升，法尤姆（从39.25升至至71.65；p<0.001）和卡夫尔谢赫（从36.44升至56.6；p=0.032）的上升尤为显著。年度比较显示，除2021年外（p=0.15），各年份不同省份之间存在显著差异，阿斯尤特的孕产妇死亡率一直最高。尽管全国孕产妇死亡率从COVID-19之前的44.1升至之后的55.9，但这一变化无统计学意义（p=0.236）。研究结果突出了孕产妇死亡人数惊人的上升，并强调需要采取有针对性的干预措施，以解决孕产妇死亡的直接原因，并在COVID-19大流行等危机期间改善医疗服务的可及性。
